Lethal Cure Read online

  Had to distract her the best I could. “Get me two wide-bore peripherals on the girl. Ringers. Open lines wide. And hook to cardiac monitor and oximeter. O2 sats every five minutes. I’ll take Juan.”

  I didn’t think this would minimize her suffering. But I had nothing more to offer her. She went to work, silent tears forming pale paths down her smeared cheeks.

  It had been Juan’s distress call we’d answered at 2:00 a.m. He and two friends, both illegal immigrants unlike him, had landed themselves in the middle of the white-slavery auction. Their girlfriends had been kidnapped for the sale. They’d been trying to get them out, when another gang crashed the scene, started eliminating the “merchandise” to drive their displeasure home—and the turf war had exploded.

  Amid a backdrop of rabid violence, Juan had panted a picture of the macabre scene. Just. With Lucia having him on speaker, we’d had first-row audio seats to his bludgeoning.

  Matt, Lucia and I had been manning the crisis post, as usual. We three didn’t have a life outside our work, or a home to go back to. Ironic really, when our team once voted us the most eligible trio. And yet, all we did with potential lovers was scare, alienate or get them killed.

  I was in a league of my own, though. I scared men off on auto, was doing my damnedest to alienate the one man I could love. And I hadn’t gotten the one who’d loved me killed. I’d killed him myself.

  Anyway, we’d immediately responded to the emergency. The others had arrived too late to do anything but wait for our field report, and get ready to receive the injured. Or to retrieve our bodies.

  Once we’d arrived, Matt and Lucia had covered me, blasted away attackers, giving me an opening to reach the victims. Three had already been cold. Three, including Juan, had been EVS—exhibiting vital signs. One of the three, a girl, had been by far the worst.

  And I’d done the impossible. I’d sacrificed her. Left her behind to expire under the feet of those warring waste of DNA, while we rescued Juan and the girl with us now.

  Lord, I abhorred triage! Being forced to prioritize those who stood a better chance—it polluted my soul.

  I wondered how many times I’d made the wrong decision, how many I’d sentenced to death….

  No time to ponder your possible crimes of omission. Save those you prioritized!

  I pressed my stethoscope around the single bullet entry wound marring the perfection of the girl’s firm, young flesh, right beside the nipple of her left breast. Her smothered heartbeats and nonexistent breath sounds made the diagnosis for me.

  I murmured it to Lucia. “Tension hemopneumothorax.” Air and blood leaking out of one lung, collapsing it, pressuring the other and the heart, stopping their function. Rapidly fatal. “Thoracostomy needle.” It materialized in Lucia’s hand, moved to mine, was between her ribs in seconds. The characteristic rush of air hissed over the shrieking of the engine. Now the blood. “Recline her up, sixty degrees. Scalpel and thoracostomy tube.”

  She carried out my orders, and I sliced between the ribs, extended the opening through her muscles and pleura with my finger, inserted the tube, hooking it to an underwater-seal bottle. Blood gushed into it. Her lungs should expand. Her heart should start to beat again. Should. But what was as it should be here?

  Time dragged, warped. I no longer heard the rumbling of the engine, or felt the heaving of the van. My eyes were glued to the monitors. They remained locked into their dismal-news patterns. My gaze dropped to my watch. Had its damn hands frozen, too? Could it be just ten minutes since we’d returned to the van? And less than a minute since the thoracostomy?

  Had to do something before my nuts and bolts started loosening. We’d done the ABCs—airway, breathing and circulation. Now I turned to D, checking for disability, and E, exposure, searching for injuries other than the obvious ones.

  Juan and the girl had a Glasgow Coma Score of six and seven respectively. In that panel for assessing neurological status, less than eight was bad news. Real bad.

  But in the girl’s case, her circulatory collapse explained her depressed consciousness. Juan’s condition could be anything from severe reversible brain edema, to irreversible brain damage. Couldn’t begin to guess which without CTs.

  I found no more injuries on either. That was something at least. Something that felt like less than nothing.

  “Mannitol bolus in Juan’s central line, Lucia,” I hissed as I placed a urinary catheter. That should bring down brain edema, lower intracranial pressure, guard against secondary brain damage. I hoped.

  “Her name is Mercedes—” Lucia suddenly choked a tear-soaked tremolo.

  Mercy. As if I needed to know that now.

  Knowing a casualty’s name always made things worse. And with her name… A wave of viciousness rolled inside me. It was good to remember the moments when I’d shown her would-be murderers none.

  If we failed to save her, I’d be back for those I’d missed. I’d be back anyway.

  It was what I did.

  Now I got back to the business at hand. “Call ahead. Have the team prepare OR. Two stations, and twenty units of O-neg. Get me Al and Savannah. I need them to handle one of these two.”

  Juan? Her bloody gloved hand clamped mine, the question clear in her drenched eyes.

  A frown pleated all the way down to my heart. I shook my head. Not Juan.

  She let my hand go, eyes gushing her agony and relief.

  Sheesh. I really understood how Atlas felt like. The weight of her mythical opinion of my surgical prowess kept getting heavier every day.

  Now we had nothing more to do until our patients responded to our measures. Nothing but wait.

  I had issues with standing aside doing nothing.

  Issues? There was a gross euphemism. Considering my reaction ranged from rage, to one temporary-insanity episode more than six years ago.

  I’d been Global Crisis Alliance’s combat-doctor tagalong on an evac mission led by Preemptive Action Counterterrorism Team in Sudan. It had all gone well, until Damian, my mission leader then, had ordered me to leave the sickest to their fate. I could still close my eyes and vibrate with the eruption of madness, burn with the suicidal intentions that had ended in me saving my patients but causing the death of two of Damian’s men. And Melissa. His lover.

  Damian had banded with PACT’s head honchos and my bosses and gotten me kicked out of GCA. Even Sir Ashton, GCA’s director then, hadn’t been able to defend me, his protégé. He hadn’t been able to stop them from revoking my medical license for good measure.

  Four years later, forced to work with me again in Russia, Damian had revealed that he considered his peoples’ blood to be on his hands, not mine. He’d ordered them to their deaths to save me. He’d ended my career not to punish me, but to stop me before I killed myself. Or worse. He’d been right. I’d been high on fanatic fervor and newfound abilities. I’d needed stopping.

  Not that I’d stopped. I’d just found my brakes. I hoped. Damian’s actions had triggered the chain reaction that led to my becoming who I was now. Still, my recklessness demon writhed constantly at the end of its throttling leash. The damn thing lived for nights like this—to be let loose. I sure was my father’s daughter.

  Must be in my genes, taking the law into my hands, when vermin gnawed holes in it to scamper free, spreading sickness and madness. I exterminated them, just like my father had before me. Just like he still did. From prison…

  “Juan’s BP is ninety over fifty.” Lucia’s statement jogged me back to our current crisis.

  Better. But not enough. Had to keep the gap between arterial and intracranial pressure above seventy. I checked his urine output. Adequate. No danger of overloading his system then. “Hang two more bags. Normal saline this time. Open as wide as you can.”

  “You think he—th-they stand a chance?” Lucia said, her voice a tear-soaked tremolo.

  I listened to Mercedes’s chest before answering. “Air entry better on the right side. Not so much on the left. Heartbeat not at al
l. I don’t know, Lucia.” Lucia’s puffy face crumpled, a mask shriveling in the flames of desperation and dread. If only I could lie. Comfort her. I couldn’t. “We’d done everything we could for now, can only wait.”

  So we did. Waited, helpless.

  I’d been that, too many times. As my baby sister died needlessly on an operating table. As my father was dragged out of my grasp and locked away forever. As my mother slipped through my fingers and disappeared.

  But Mercedes with her punctured chest…she echoed the horror and despair of another time.

  Four months ago on a crisp October day. In a cave in the Caucasus Mountains on the Russian border. In the ghastly epilogue to the hostage-retrieval mission that had turned out to be anything but. Stumbling in on the only two men I’d ever loved, to find one torturing the other to death.

  I’d stopped Damian, protected Jake, demanded answers from both at gunpoint. I’d only gotten more mental blows with every accusation they’d hurled at each other. Then the final shock that had almost fractured my mind—when Jake had shot Damian. In cold blood. Through the heart.

  It had become clear then. How both had been consummate liars. But one of them—Jake—had been also a megalomaniac with a genocidal agenda.

  And I’d had to let him escape. Damian had lain at my feet, his heart suffocating on its own blood, every beat sweeping him away from me forever.

  God. I’d thought that Damian was beyond me. Beyond anything.

  I had to admit though, handling Mercedes’ injury felt nothing like handling Damian’s. I wouldn’t want to die if she did. Guess it was only human—to feel desperation chomping holes in my heart, to feel my will to live fading, when it had been my lover dying.

  Well, he wasn’t my lover. My mentor, sure. My nemesis for quite a while, certainly. My unwilling ally and indispensable partner when circumstances dictated, yeah. But not my lover.

  So I loved him, with every last tempestuous spark of my being, but what’s that got to do with anything? So I had slept with him, but it was only one time…. Okay, so it was one night, one endless, transfiguring, sex-fest of a night, but…

  Okay. Fine. Let’s call him my lover, just for simplification’s sake.

  But the situation had been more desperate for other reasons, too. Hemopneumothorax had nothing on cardiac tamponade. That topped the list of rapidly fatal injuries.

  The bullet had ripped one of his heart’s great vessels, strangling it in its own leaking blood. I bet Jake had meant it to do just that. I’d been in a cave, alone, with minimal equipment. Going mad, going to pieces and going numb hadn’t been helping either. I’d had to stick a needle into his pericardium blindly, to siphon off the strangulating blood. Over and over. I’d prayed and begged for him to hang on until I could get him into surgery.

  And he had. We’d sawed open his chest and sewed up his injuries. His heart had stopped twice. And I’d pumped it back to life, with my own hands.

  Then I’d gone after Jake and pumped his full of poison. A drug that would paralyze him totally, make him unable to breathe.

  I hadn’t stuck around to watch him suffocate as I knew he would. I’d run. But not before he’d had his final revenge on me. He’d left me with a festering curse. His last look of understanding—and absolute love.

  “Her pressure’s going up.” Lucia’s hoarse words knocked down the constricting walls of memories. I let go, let tremors engulf me. It always felt like a stay of execution when a critical patient responded.

  “You’re doing great, Mercedes,” I choked. I always talked to critical patients, hoped they could feel me fighting for them, tiding them over the worst. “Just hold on a little longer, and we’ll fix you up.”

  If she could be fixed.

  Two

  Matt got us to the Sanctuary in one piece. Our patients were hanging on. Just.

  Lucia and I snapped the bullet-riddled doors open and were jumping out before the van came to a screeching stop, kicking up mold-infested sludge in the Sanctuary’s back alley entrance.

  Ayesha ran out to meet us, her long, powerful ebony body swathed in black, looking nothing like the angel of mercy that she was. Our trauma team was right behind her. They swooped en masse, fluidly practiced, über-efficient, transporting our casualties inside in under a minute.

  I ran next to Fadel and Ishmael. “Get me head CTs on Juan, stat. Use the 640-slice machine.”

  They shot me surprised glances. Ishmael articulated his skepticism. “You reported possible intracranial hemorrhage. Shouldn’t we go for craniotomy at once?”

  I shook my head. “Controlling ICP is more important to preventing brain herniation and to prognosis than prompt hematoma evacuation. And CT isn’t a luxury here. It’s a crucial emergency measure, especially if we operate. If hemorrhage is collecting inside there somewhere, knowing exactly where will mean a precise approach during surgery. Anyway, our new CT will wrap up the whole thing in seconds. If he deteriorates he’ll be on the table in a heartbeat. Just keep both his systolic pressure and O2 sats above ninety.”

  Ishmael nodded, accepting my decision. My heart fired. The dread never went away, never lessened. Every time, with each injection and procedure and diagnosis, every wielding-power-over-life decision, everything inside me quivered, went queasy with fear. What if I was wrong?

  God, where was Matt now? He should be taking over, taking responsibility. At least, sharing it.

  My gaze and thoughts followed Ishmael and Fadel as they directed their team, wheeling Juan to the CT suite, a synchronized machine I knew would do the job in minimal time.

  They were another two of my core eight. An ultimate example of what we were all about. Could any two people be more different? Each came from a different world, poles apart in every way. Age, race, background, character. Yet they were the same. On top of their game, dedicated—and not a little wacky. At least by this world’s definition, a world that glorified conformity and the pursuit of personal safety and gain. Our Sanctuary was a miniature United Nations of the unorthodox and intrepid, an asylum for misfits who’d decided there had to be another way, and were trying as hard as they could to find it. Just knowing they existed made this planet habitable for me. Yeah. They were reason enough.

  Too bad they weren’t the dominant species. But we’d banded together, and our numbers were growing. We’d get there. One day.

  Ayesha’s prompting touch dragged my focus back. “Let’s get you ready for surgery.”

  Ready? How could I ever be, when I stuck myself between life and death, taking the responsibility of minimizing damage and warding off mortality? When I invaded a person’s fate with my scalpel and imperfect knowledge?

  I ran to Scrubbing and Gowning. The preoperative rituals helped. Swathed me in the illusion of control, preparedness.

  “You got Al and Savvy?” I panted as I yanked off wet, blood-splattered clothes.

  She nodded. “They’re on their way any second now.”

  “I’m leaving them the cardiothoracic case.”

  She blinked. “Thought you’d leave them the head injury. You hate head injuries.”

  “Yeah, and they love me. Personally and professionally.” I snapped up the soap, worked a furious lather. “I promised Lucia.” Her trembling hand and eloquent tears had bound me, inextricable as a blood oath. If he dies, I want him to die with you fighting for him, they’d said.

  A cold fist unfurled in my chest. Times like this made me want to renege on all my oaths, Hippocratic and otherwise, go hide somewhere responsibility-free. They made me wonder why I wasn’t hanging up my drugs and guns, tracking down Mom, and joining her in whatever reclusive serenity she’d found.

  Times like this also made me grateful I’d trained to do something about life’s atrocities, was equipped to fight back, on so many levels now. Whether I made a difference or not remained to be seen. Which was never the issue. Trying was.

  I finished scrubbing, held my hands up to dry, for Ayesha to snap gloves on them. What would I do without
her? My left hand—she called herself that. To me, she was my back. She got my back, made it all possible. She anchored my resolve, shared my quirks, amplified my strength. She understood.

  Too much sometimes. Like now. Her interrogating gaze asked first. Then she made it vocal. “How many did you lose?”

  I exhaled, severed eye contact, jumped into scrubs. The confession was still wrung from me. “Three were already lost. One, I left.”

  She gritted her teeth, ran ahead, put her back to the OR’s swinging door. “How many did you take out?”

  I ignored the question, rushed inside, took in the scene. Mercedes being cleaned up and prepped, Ishmael and Fadel wheeling Juan in, others wrapping up pre-op routines. My eyes snapped back to Ayesha. She was waiting for her answer, patiently. Imperatively.

  I shrugged. “I didn’t count. I lost count.”

  “Good.” Ayesha’s rich voice was even. Calm. Ruthless.

  Good thing she was on our side.

  Al and Savannah burst into the OR right behind us.

  “What have you got for us?” Savvy, already gowned and masked, asked without even looking at me, her eyes where they should be, scanning for the patient she’d come to fight for.

  “Close-range, high-caliber bullet, lower left chest. Massive hemopneumothorax, collapsed left lung. Chest tube in place, which evacuated over a liter of blood with more still coming. On aggressive fluid replacement. No transfusion. She’ll just bleed it back through the injuries. She needs a thoracotomy stat to plug the holes and repair the damages.”

  With Savvy’s deep scarlet hair and stunning face smothered in cap and mask, only her angelic blue eyes displayed her reaction. She was a new recruit and a damn good surgeon. A little weird, too. Had to be, to choose wading in blood, and waging endless battles on the side of the outnumbered good guys for a living. Welcome to the club, I’d said the day she’d hooked up with us three months ago.

  She’d heard stories of a probably mythical taskforce that dispensed aid outside every public and private system. An outfit that didn’t only save victims but went after aggressors, that didn’t only rehabilitate drug addicts, but wiped out drug lords, and made use of their spoils to finance more cleanup and aid operations. Not to mention to stock up on a unique arsenal of drug-based weapons, and a full range of both improvised and conventional ones.