Cold to the Touch

by Cari Hunter

  “Where is he now?” Eleanor asked, before Carlyle could respond.

  “Taking a nap in Interview One,” George said.

  “Good. Let’s leave him there if he’s comfortable. The later we release him, the better our chances at the shelter. I’m going to pull Scotty and Jay in to help with the interviews tomorrow, and I’ll co-opt a few unis for the preliminaries as well.”

  Sanne raised an eyebrow, but Carlyle said nothing about the supposed “special project” to which he had assigned Scotty and Jay. Not that she cared overly much. If the case turned out to be a multiple murder, then he’d done her a favour by shoving it onto her workload, although his self-satisfied smile told her he’d not fathomed that.

  Someone had been playing hangman on the front sheet of the flipchart that Eleanor dragged over to the desks. She tutted at a misspelling, tore the sheet off, and tossed it into the bin.

  “I’m not taking this any further up the chain of command until we’ve been to the Mission,” she said. “If—and it’s a big if—the DCI accepts that the cases are connected, he’ll want to involve the press, and I can think of no surer way of sending every Malory Park scrote bag scurrying for cover. So, let’s make a to-do list, shall we?”

  An hour later, the flipchart was down to its final page, the milk had run out, and Sanne’s right leg had developed an uncontrollable twitch. While it was good to see everything broken down and itemised, nothing of any real significance had arisen during the discussion, and frustration had left everyone short-tempered and fidgety.

  “Okay, I think it’s time we called it a night.” Eleanor sounded as disillusioned as everyone looked. “Be here for a briefing tomorrow at nine, and we’ll travel to the Mission in convoy.”

  Sanne stifled a groan as she massaged the pins and needles from her thigh. The rumble of furniture being rearranged covered the sound of someone kicking her chair. Startled, she turned to find Carlyle watching her, his head tilted slightly, as if she were a scientific curiosity he couldn’t decide whether to pin under his microscope or crush beneath his shoe.

  “I don’t know how you do it, Jensen,” he said, his voice lowered to ensure it didn’t carry. “You snap your fingers and the boss comes running every damn time.”

  She stood up, which didn’t exactly put her on his level but made her feel less vulnerable all the same. “If you have a problem with any of this, Sarge, you need to speak to the boss, not me.”

  “You know what? I do have a problem. I don’t like wasting my weekend because you mistook a bunch of coincidences for genuine leads.”

  She could feel heat prickling her face and fought to keep her voice steady. The sole aim of any bully was to provoke a reaction. “I think you should be having this conversation with the boss, Sarge,” she repeated. From the corner of her eye, she saw Nelson starting toward them, and she shook her head once to ward him off.

  “Yeah, I might pass on that,” Carlyle said. “You set this ball rolling, Jensen, so why would I want to stop it?” He collected his jacket and strode past her, careful not to make contact but coming close enough to force her back a step.

  “Arsehole,” she muttered, as he passed Eleanor’s office without pausing.

  Nelson approached once the coast was clear. “What did he want?”

  “Oh, just to let me know that he’s looking forward to seeing me fall flat on my face.”

  “That was good of him.” Nelson handed her her bag, and they began to walk toward the lift. “I always find those kinds of chats highly motivational.”

  She frowned. “You do? He makes me want to punch him in the head.”

  “You’ve got to think outside the box, San. Carlyle sets a standard for everyone.”

  The lift pinged and its doors swept open.

  “Yeah,” she said. “The better you do your job, the more you piss him off.” She thought about that for a second, and her face brightened as the penny dropped.

  Nelson started to laugh. “See what I mean?” he said. “Brilliant motivation.”

  *

  The shoulder returned to its socket with an audible click, a success lost on its owner, who had drunk enough whiskey to sedate an elephant and hadn’t needed to be anaesthetised.

  Meg stepped forward, more concerned about Asif, the F2 performing the reduction, than his insensible patient. Wan-faced at the bedside, he was swallowing rapidly.

  “Good job,” she said. “Distal pulse is fine, and her hand is well perfused. So, collar and cuff, X-ray, and then it’s just a case of sobering her up and arranging an outpatient appointment. What would you have tried had the Kocher’s method failed?”

  “Modified Milch,” he answered promptly, far more confident in theory than he was in practice. “Then Hippocratic as a last resort.”

  “Excellent. Always remember to take your shoes off before that one, though.”

  He smiled, the colour returning to his cheeks. “Thanks for your help, Dr. Fielding.”

  “Meg,” she reminded him, although her attempts at informality were proving futile. She felt her phone vibrate and checked the text: Sanne, Give me a ring when you can. She poked her head between the shock room curtains and looked around the rest of the Resus bays. Three were empty, and Liz was chatting to the patient in the fourth.

  “Will you be all right in here for a few minutes?” she asked Asif.

  He nodded, too busy wrestling with the padded sling to glance up.

  “I’ll be in the ambulance bay if you need me. If Donovan needs me, tell him I’ve nipped to the loo.”

  A lone ambulance stood in the bay, its crew hiding behind it to sneak a cigarette. Meg shuddered as an icy gust of wind hit her, her numb fingers fumbling with the phone.

  “Sit in the back, Doc,” a familiar voice called. “The heater should still be on.”

  Through the cloud of smoke, Meg recognised Kathy, a paramedic with a knack of attracting bad or just plain weird jobs. The last time Meg had seen her, she’d been attempting to resuscitate a fifty-year-old who’d expired while dressed as Father Christmas.

  “Bloody hell. If I’d known you were on, I’d have booked the night off.”

  Kathy all but choked on her cigarette. “Likewise! I only turn into a shit-magnet when you’re working. We just brought in a bloke who’d tried to ice skate on a pond, only he didn’t have any skates.”

  “Or enough ice,” her mate chipped in.

  Halfway up the ambulance steps, Meg stopped and grinned. “Well, you know how the saying goes: We can’t fix stupid, we can only sedate it.”

  “They should stick that on a sign above the main entrance,” Kathy said, and took a long drag on her cigarette.

  After shutting out the cold and the smoke, Meg chose the back seat and dialled Sanne’s number.

  Sanne answered through a mouthful of something. “Hphm. Sorry. Hello.”

  “Hello yourself. What’s that you’re eating?”

  “Chocolate HobNob. Eleanor bought chippy for us all, so I’m having dessert.”

  Meg nestled down in the seat, propping her feet on the stretcher frame. “Are you working weekends now?”

  “Yeah.” There was a pause, as if Sanne was deciding how much to divulge. “Our Malory Park stabbing might be linked to another. I drew the short straw and had to call the boss in.”

  “You drew the straw or the connection?” Meg asked, detecting the conflict in Sanne’s voice.

  “Both. It’s all been quite stressful.”

  The understatement made Meg smile. “I can imagine.”

  “Anyway.” Sanne was straight back to business. “Enough about me, I wanted to see how you were.”

  “I’m fine. It’s all gone quiet on the Luke front. And I loved my mug. Thank you.”

  “I bet you loved the bacon more.”

  The mere mention of the thick cut, smoky slices she had found in her fridge set Meg’s mouth watering. “You know me too well, Sanne Jensen.”

  “You are easy to please,” Sanne said, and quickly cov
ered her accidental innuendo with ostentatious crunching.

  Meg held the phone away from her ear so Sanne wouldn’t hear her laughing. When she put it back, Sanne was telling her something about a “Fwin.”

  “You checked the what now?”

  “The Force Wide Incident Number. It’s a unique reference attached to a reported incident. I’ve looked at the one assigned to your break-in, but there’s been no movement on it.”

  Meg nodded, unsurprised. “Any luck with the unofficial side of things?”

  “Not yet, but then I only put the word out yesterday.”

  “Don’t worry, San.” She could hear footsteps, interspersed with the occasional bang, and imagined Sanne pacing across her kitchen, kicking out at unfortunate items of furniture. “You’ve got enough on your plate as it is.”

  “You just keep in touch.” Sanne’s voice was quiet and intense. “Promise me?”

  “I promise.”

  The ambulance doors slammed as Kathy and her mate got into the cab. Seconds later, a high-pitched beeping was drowned out by a tirade of colourful curses.

  “I’ve got to go,” Meg said as the engine started. “I’ll speak to you soon.”

  “Okay. Have a good shift.”

  Meg thought of the spare beds in her Resus, of Donovan safely sequestered in Minors, and of the breach manager’s absence. “It’s been nice so far,” she said, climbing back down into the chill of the ambulance bay. “Long may it continue.”

  *

  “Henoch-Schönlein purpura,” Meg said, and stuck out her tongue as Liz pulled a face. “What? It affects the small arteries in the kidneys, skin, and GI tract.”

  Liz shook her head and continued to sort through the supplies in the shock room. “I knew I shouldn’t have played this with a bloody doctor. What letter are we up to? I…I…Influenza.”

  “Jackson-Weiss syndrome.”

  “Oh, shut up!”

  Laughing, Meg caught the suture pack that Liz hurled at her and tucked it in a drawer. Before Liz could throw anything else, the shrill chime of the Bat Phone signalled an abrupt end to the game. Meg snatched up the receiver and found the pen she had stuck in her hair. The dispatcher relayed rapid-fire details, his urgency raising goose pimples on Meg’s neck. Having read the first line over Meg’s shoulder, Liz yelled for Asif and reached for another phone.

  “How long?” she asked as Meg hung up.

  “Six minutes. Four wounds to central chest and abdo. He’s bleeding out. Fast bleep Cardiothoracic.” Meg knelt by the blood fridge and began to gather bags of O-negative. “Asif, prep for bilateral chest drains. Have you done one unsupervised yet?”

  He shook his head, and she tried very hard not to swear.

  “Well, this may be a first for you. Let’s get the thoracotomy tray ready for the cardiothoracic chaps. Hopefully, they’ll be here to help us out, if it comes to that.”

  “Is he intubated?” Liz, ever the pragmatist, was adjusting the settings on the vent.

  “No, still breathing, but I think we’ll be needing this.” Meg opened the sterile airway pack. “Can you get hold of Anaesthetics as well?”

  “Already did. Sahil’s on his way down. I’ve paged Donovan, but he’s on a break somewhere.”

  Meg smiled, grateful for competent backup. “Y’know, it’s not true what they say about you.”

  “Some of it is.”

  Meg almost knocked Sahil off his feet as the sound of approaching sirens sent her dashing to the door. “Adult male, multiple central stab wounds, GCS nine and dropping,” she told him. “Vent’s good to go.”

  He saluted and hurried past her into the shock room. Right on cue, an ambulance streaked into the bay, its lights still blazing.

  “I might’ve guessed,” Meg muttered, recognising Kathy’s mate, his uniform and forearms now covered in blood. Grim-faced, he worked the ramp mechanism as Kathy unhooked an IV bag and gave Meg a single distraught glance.

  “He’s peri-arrest,” she said. “Brady at forty, can’t get a systolic. Half his fucking guts were hanging out when we got there. Police are right behind us.”

  Meg nodded, taking in the failing heart rate on the monitor, the stertorous breaths, and the blood soaking the dressings and dripping onto the floor. The man’s eyes were open but unseeing, his skin a waxy, jaundiced colour. His right hand flexed as if reaching for something and then fell limp against the stretcher.

  “Shock room’s ready,” she said. She held up the fluid and squeezed the bag, trying not to trip over the stretcher as she ran alongside it. The instant it bumped the hospital bed, she nodded to Kathy, who began her handover as the team rolled and checked the man’s body.

  “Unknown male, found in the street by a passerby. Stab wounds to left and right upper chest, and two to the lower abdomen, with evidence of massive blood loss. Breath sounds are poor. I wrapped his bowel in a wet dressing.” Kathy faltered, checking the scribbles on the back of her glove to see what she’d omitted.

  “How much fluid has he had?” Meg prompted her gently.

  “That bag will make it two litres.” Kathy had started to move with more purpose, helping to attach leads and unravel tubing. “Do you want us to stick around?”

  “That’d be great.” Meg turned to Liz. “Any word from cardio?”

  “No, not yet.”

  “Fucking hell.”

  One of the stab wounds was just below the heart and angled upward, and the man was on the verge of cardiac arrest. In Meg’s book, he ticked most of the boxes indicating an emergency thoracotomy. On the monitor, the heart rate slowed to twenty-eight, stamping out her indecision. She tore open a set of defib pads and slapped them into place.

  “Asif, get a drain in on the right. Sahil, can you give him a hand once you’ve intubated? Liz, you’re with me on thoracotomy duty. Can someone start compressions? He’s doing fuck-all with a rate that poor.”

  Kathy stepped up to the mark, but the monitor screeched before she could get her hands into position. “VF!” she called.

  “Everyone clear?” Meg hit the shock button. Two hundred joules fired through the man’s chest, jerking his limbs and sending him straight into asystole.

  “Go,” she told Kathy, who started to pump the chest in smooth, hard compressions. “First adrenaline’s in.”

  She opened the left chest wall, parting skin and fat with a scalpel and then hacking through the intercostal muscles with scissors. Without warning, blood sloshed out onto the floor, a warm, lurid wave that splattered her legs and trainers. Sahil muttered something in Urdu that was probably a prayer as Meg shoved the rib retractors into place and cranked them open, ignoring the pain that shot through her bad wrist. A vertical cut across the pericardial sac sent more blood pouring into the chest cavity and revealed the damage to the heart: a jagged wound in the thick muscle of the left ventricle.

  “Jesus,” she whispered, astounded that the man had lived long enough to reach the hospital. “Not a hope in hell.”

  Nevertheless, she covered the wound with her finger and began to squeeze the heart between her hands, counting out a rhythm in her head as she watched fresh blood race through the IV lines.

  “If anyone finds a bleeder, suture it or stick something on it,” she said. “Asif, how’re you doing?”

  “Drain’s in.” He looked across the patient at her, his eyes wide. “Almost a litre out already.”

  “Aw, shit. Are we getting any volume into him at all?”

  “No,” Asif said, as Sahil shook his head. “Nothing.”

  Meg quickly considered her options. “Okay, one last try. Asif, come and take over this for me. I’m going to stitch this lac, so keep it nice and smooth.”

  Although she’d never put sutures directly into myocardium before, it wasn’t as if she could make anything worse. She worked fast, tying off large, clumsy stitches that succeeded in plugging the hole and holding together under the stress of the direct massage. It took nine to keep the laceration closed, and when she had finished, abs
olutely nothing happened. Whenever Asif paused, the line went flat on the monitor, and the transfusions continued to pour in blood that failed to get anywhere near the heart. When the sixth adrenaline had gone in, Meg checked the clock on the wall: they had been working on the man for half an hour. She wiped sweat from her forehead with the back of her arm.

  “Everyone in agreement?” she asked. She didn’t need to say anything else. There were nods all around. “Right then, I’m going to call it. Time of death, eleven thirty-seven p.m. Thank you all. I’m sure his family will appreciate your efforts. Just leave everything as it is until I’ve spoken to the police.”

  The air left the tube with a reluctant sigh as Sahil disconnected the vent. He touched the bloodstained cross hanging from the man’s necklace, his lips moving soundlessly, and Meg turned away to grant him privacy. She was tearing off her apron when multiple footsteps approached the shock room and the curtain surrounding the cubicle was yanked aside.

  “You’ve already stopped?” Donovan—red-faced and visibly fuming—stated the obvious through clenched teeth. Two surgeons stood either side of him, staring at the carnage on the bed. Meg wondered whether they’d been exchanging golfing anecdotes in the corridor while she’d been splitting the man’s ribcage.

  “Yes,” she said, daring him to take issue with her decision after he’d ignored an urgent request for assistance. “His entire blood volume is either in his chest or on the floor.”

  Donovan grunted and surveyed the body, evaluating Meg’s interventions from the airway down to the open-heart surgery. Apparently finding nothing to criticise, he grunted again and left the room with the surgeons close behind him.

  Meg shut the curtain and stared at the blood clotting on the tiles until her eyes blurred and she felt less like screaming. Once she had regained her composure, she took the time to study the man’s body.

  “You poor bastard,” she whispered.

  His slackened features were free from pain or distress, and Sahil had closed his eyes with tape, but there was no denying the brutality of his death or of the attempts to resuscitate him.