“Grace, we need a lot more wood for the fire. Go out and get some. Grace, go!”
His sharp words snapped her back to attention. She gave a dazed nod and left the house, admitting a cold draft of wind as the door shut behind her.
“Jesus,” murmured Doug, turning his full attention to Arlo’s left leg. “Where do we start?”
Start? There was so little left to work with, just twisted cartilage and torn muscles. The ankle had been rotated almost 180 degrees, but the foot itself was bizarrely intact, although it was a lifeless blue. It might have been mistaken for plastic were it not for the thick and all-too-real callus on the heel. It’s dying, she thought. The limb, the tissue itself, was starved of circulation by the tourniquet. She did not have to touch the foot to know that it would be cold and pulseless.
“He’s going to lose the leg,” said Doug, echoing her thoughts. “We’ve got to loosen the tourniquet.”
“Won’t he start bleeding again?” asked Elaine. She remained at the other end of the room, her gaze averted.
“He’d want us to save his leg, Elaine.”
“If you take off the tourniquet, how are you going to stop him from bleeding?”
“We’ll have to ligate the artery.”
“What does that mean?”
“Isolate the torn vessel and tie it off. It will interrupt some of the blood flow to the lower leg, but he still might have enough alternative circulation to keep the tissues alive.” He stared down at the leg, thinking. “We’ll need instruments. Suture. There’s got to be a sewing box in this house. Tweezers, a sharp knife. Elaine, get some water boiling.”
“Doug,” Maura said. “He’s probably ruptured multiple vessels. Even if we ligate one, he could bleed out through the others. We can’t expose and ligate them all. Not without anesthesia.”
“Then we might as well amputate it right now. Is that what you’d have us do? Just give up on it?”
“At least he’ll still be alive.”
“And missing his leg. That’s not what I’d want if I were him.”
“You’re not him. You can’t make this decision for him.”
“Neither can you, Maura.”
She looked down at Arlo and considered the prospect of slicing into the leg. Of digging through flesh that was still alive and sensate. She was not a surgeon. The subjects who ended up on her table did not spurt blood when she cut into them. They did not scream.
This could turn into one big, bloody mess.
“Look, we have two choices,” said Doug. “Either we try to save the leg, or we leave it the way it is and let it necrose and turn gangrenous. Which could kill him anyway. I don’t see that we have a lot of options here. We have to do something.”
“First do no harm. Don’t you think that applies here?”
“I think we’ll regret not acting. It’s our responsibility to at least make an attempt to save that leg.”
They both looked down as Arlo sucked in a ragged breath and moaned.
Please don’t wake up, she thought. Don’t make us cut you while you’re screaming.
But Arlo’s eyes slowly opened, and although his gaze was cloudy with confusion, he was clearly conscious and trying to focus on her face. “Rather … rather be dead,” he whispered. “Oh God, I can’t stand it.”
“Arlo,” said Doug. “Hey, buddy, we’re going to get you something for the pain, okay? We’ll see what we can find.”
“Please,” Arlo whispered. “Please kill me.” He was blubbering now, tears leaking from his eyes, his whole body quaking so hard that Maura thought he was convulsing. But his gaze remained fixed on them, pleading.
She draped a blanket over his exposed body. The fire in the hearth was burning brightly now, revived by a fresh load of wood, and with the rising warmth the smell of urine grew stronger.
“There’s Advil in my purse,” she said to Doug. “I left it back in the Jeep.”
“Advil? That’s not going to touch this.”
“I have Valium,” groaned Arlo. “In my backpack …”
“That’s up in the Jeep, too.” Doug stood. “I’ll go get our stuff and bring it all back.”
“And I’ll search the houses,” said Maura. “There’s got to be something in this valley we can use.”
“I’ll go with you, Doug,” said Elaine.
“No. You need to stay here with him,” Doug said.
Reluctantly Elaine’s gaze dropped to Arlo. Clearly this was the last place she wanted to be, trapped with a sobbing man.
“And boil some water,” Doug said as he crossed the door. “We’re going to need it.”
Outside, the wind lashed Maura’s face with stinging clouds of snow, but she was glad to be out of the house and breathing fresh air that did not stink of blood and urine. As she headed toward the next house, she heard footsteps crunching behind her, and she turned to see that Grace had followed her.
“I can help you look,” said Grace.
Maura eyed her for a moment, thinking that Grace would probably be more of a hindrance. But at that moment, the girl looked lost, just a frightened kid whom they had ignored for far too long.
Maura nodded. “You could be a big help, Grace. Come with me.”
They climbed the porch steps and pushed into the house.
“What kind of medicines are we looking for?” asked Grace as they headed up the stairs to the second floor.
“Anything. Don’t waste any time reading the labels. Just take it all.” Maura went into a bedroom and stripped off two pillowcases. She tossed one to Grace. “You search the dresser and nightstands. Look anyplace they might keep their pills.”
In the bathroom, Maura scanned the contents of the medicine cabinet, tossing items into her pillowcase. She left behind the vitamins but took everything else. Laxatives. Aspirin. Hydrogen peroxide. Any one of those might be useful. She could hear Grace in the room next door, opening and slamming shut drawers.
They moved on to the next house, their pillowcases rattling with bottles. Maura was first through the front door, stepping into a home where silence hung as heavy as gloom. She had not set foot in this house before and she paused, glancing around the living room. At yet another copy of the now familiar portrait hanging on the wall.
“It’s that man again,” said Grace.
“Yeah. We can’t seem to get away from him.” Maura took a few steps across the room and suddenly halted. “Grace,” she said quietly.
“What?”
“Take the pills back to Elaine. Arlo needs them.”
“We haven’t looked in this house yet.”
“I’ll do it. You just go back, okay?” She handed the girl her pillowcase of pill bottles and gave her a nudge toward the door. “Please, go now.”
“But—”
“Go.”
Only after the girl had left the house did Maura cross the room. She stared at what Grace had not seen. The first thing she’d spotted was a birdcage, the dead canary lying on the bottom, just a tiny mound of yellow on the newsprint cage liner.
She turned and focused on the floor, on what had stopped her in her tracks: A smear of brown tracked across the pine planks. Following the drag mark, she moved into the hallway and came at last to the staircase.
There she halted, staring at a frozen puddle of blood at the bottom of the steps.
As her gaze lifted toward the second floor, she imagined a body tumbling down those steep stairs, could almost hear the crack of a skull as it bounced down the steps and smashed onto the floor near her feet. Someone fell here, she thought.
Or was pushed.
By the time she walked back into their house, Doug had already returned with their belongings from the Jeep. He unzipped Arlo’s backpack and dumped the contents onto the coffee table. She saw sinus tablets and nose spray, sunscreen and ChapStick, plus a whole drugstore’s supply of toiletries. Everything a man needed to stay well groomed, but nothing to help him stay alive. Only when Doug unzipped one of the side pockets did he find t
he pill bottle.
“Valium, five milligrams. As needed for back spasms,” he read. “It’ll help him get through this.”
“Doug,” Maura said softly. “In one of the houses, I found—” She stopped as Grace and Elaine walked in the room.
“You found what?” Doug asked.
“I’ll tell you later.”
Doug spread out all the medications that they’d scavenged. “Tetracycline. Amoxicillin.” He shook his head. “If his leg gets infected, he’s going to need better antibiotics than these.”
“At least we found some Percocet,” said Maura, uncapping the bottle. “But there’s only a dozen pills left. Do we have anything else?”
Elaine said, “I always have some codeine in my …” She stopped, frowning at what Doug had brought back from the Jeep. “Where’s my purse?”
“I only found one purse.” Doug pointed to it.
“That’s Maura’s. Where’s mine?”
“Elaine, that’s all I saw in the Jeep.”
“Then you missed it. There’s codeine in it.”
“I’ll go back for it later, okay?” He knelt down beside Arlo. “I’m going to give you some pills, buddy.”
“Knock me out,” whimpered Arlo. “Can’t stand this pain.”
“This should help.” Doug gently lifted Arlo’s head, slipped two Valiums and two Percocets into his mouth, and gave him a swallow of whiskey. “There you go. We’ll give that medicine some time to work first.”
“First?” Arlo coughed on the whiskey, and fresh tears leaked from his eyes. “What do you mean?”
“We need to work on your leg.”
“No. No, don’t touch it.”
“Your circulation’s been cut off by the tourniquet. If we don’t loosen it, your leg’s going to die.”
“What are you going to do?”
“We’re going to tie off the ruptured artery and control the bleeding that way. I think you’ve damaged either the posterior or anterior tibial artery. If one of them is still intact, it might be enough circulation to supply your leg with blood. And keep it alive.”
“That means you’re going to have to dig around in there.”
“We need to isolate which artery is bleeding.”
Arlo shook his head. “No way.”
“If it’s the anterior tibial, we only have to slide between a few muscles, just below the knee.”
“Forget it. Don’t touch me.”
“I’m thinking of what’s best for you. There’ll be a little pain, but in the end you’ll be glad I—”
“A little? A little?” Arlo croaked out a desperate laugh. “Stay the fuck away from me!”
“Listen, I know it hurts, but—”
“You don’t know shit, Doug.”
“Arlo.”
“Stay away! Elaine, for God’s sake, make him stay away!”
Doug rose to his feet. “We’ll let you rest, okay? Grace, you stay here with him.” He looked at Maura and Elaine. “Let’s go in the other room.”
They met in the kitchen. Elaine had left a pot of water to heat on the woodstove, and it was now simmering, ready to sterilize instruments. Through the steam-fogged window, Maura could see the sun was already dropping toward the horizon.
“You can’t force him to go through this,” said Maura.
“It’s for his own good.”
“Surgery without anesthesia? Think about it, Doug.”
“Give the Valium some time to work. He’ll calm down.”
“But he won’t be unconscious. He’ll still be able to feel the incision.”
“He’ll thank us for it later. Trust me.” Doug turned to Elaine. “You agree with me, don’t you? We can’t just give up on his leg.”
Elaine hesitated, obviously torn between the two terrible options. “I don’t know …”
“Ligating the artery is the only way we’ll be able to remove that tourniquet. The only way we can restore some blood flow.”
“Do you really think you can do it?”
“It’s a straightforward procedure. Maura and I both know the anatomy.”
“But he’ll be moving around,” said Maura. “There could be a lot more blood loss. I don’t agree with this, Doug.”
“The alternative is to sacrifice the limb.”
“I think the limb is already a lost cause.”
“Well, I don’t.” Doug turned back to Elaine. “We need to vote on this. Do we try to save his leg or not?”
Elaine took a breath and nodded. “I guess I’m with you.”
Of course she would be. Arlo was right. She always sides with Doug.
“Maura?” he asked.
“You know what I think.”
He glanced out the window. “We don’t have a lot of time. We’re losing our daylight and I’m not sure we’ll be able to see enough with the kerosene lamp.” He looked at Maura. “Elaine and I both vote to go ahead with this.”
“You forgot a vote. There’s Arlo’s, and he made it pretty clear what he wants.”
“He’s not competent to make any decisions right now.”
“It’s his leg.”
“And we can save it! But I need your help. Maura, I can’t do it without you.”
“Dad?” Grace was standing in the kitchen doorway. “He doesn’t look so good.”
“What do you mean?”
“He’s not talking anymore. And he’s snoring really loud.”
Doug nodded. “The drugs must have kicked in. Let’s get some instruments boiling. And we’ll need needles. A spool of thread.” He looked at Maura. “Are you with me or not?”
It doesn’t matter what I say, she thought. He’s going to do it anyway.
“I’ll see what I can find,” she said.
It took them an hour to collect and sterilize all the items they’d managed to scavenge. By then, the window admitted only a weak afternoon glow. They lit the kerosene lamp, and by the light of the hissing flame, Arlo’s eyes were sunken in shadow, as though his soft tissues were collapsing, his body consuming itself. Doug peeled back the blanket, releasing the sharp smell of the urine-saturated rug.
The leg was as pale as a shank of cold meat.
No amount of scrubbing could cleanse all the bacteria from their hands, but Doug and Maura tried anyway, lathering and rinsing until their skin was raw. Only then did Doug reach for the blade. It was a paring knife, the most delicate one they could find, and they had sharpened it before sterilizing. As he knelt over the leg, the first hint of uncertainty flickered in his eyes. He glanced up at Maura.
“Ready to release the tourniquet?” he said.
“You haven’t tied off the artery yet,” said Elaine.
“We need to identify which artery it is. And the only way is to see where he’s bleeding. You need to hold him still, Elaine. Because he’s going to wake up.” He glanced at Maura and nodded.
She barely loosened the tourniquet and a spurt of blood exploded from the wound, splattering Doug’s cheek.
“It’s the anterior tibial,” said Doug. “I’m sure of it.”
“Tighten the belt!” Elaine said, panicking. “He’s bleeding too much!”
Maura refastened the tourniquet and looked at Doug. He took a breath and began to cut.
At the first slice of the knife, Arlo jolted awake with a scream.
“Hold him! Hold him still!” Doug yelled.
Arlo kept screaming, battling them away, the tendons on his neck so taut they looked ready to snap. Elaine wrestled his shoulders back to the floor, but she could not stop him from thrashing and kicking at his torturers. Maura tried to pin his thighs, but blood and sweat had made his bare skin slippery, so she threw her weight across his hips. Arlo’s scream rose to a shriek that penetrated straight to her bones, a shriek so piercing it felt as if the sound were coming from her own body, as if she were screaming as well. Doug said something, but she couldn’t hear him through that scream. Only when she glanced up did she see that he had set down the knife. He looked exhaust
ed, his face gleaming with sweat even in that cold room.
“It’s done,” he said. Rocking back on his knees, he wiped his sleeve across his forehead. “I think I got it.”
Arlo gave an agonized sob. “Fuck you, Doug. Fuck all of you.”
“Arlo, we had to do it,” said Doug. “Maura, loosen that tourniquet. Let’s see if we got the bleeding controlled.”
Slowly Maura released the belt, half expecting to see another gush of blood. But there was no trickle, not even a slow ooze.
Doug touched Arlo’s foot. “The skin’s still cool. But I think it’s starting to pink up.”
She shook her head. “I don’t see any perfusion.”
“No, look. It’s definitely changing color.” He pressed his palm against the flesh. “I think it’s warming up.”
Maura frowned at skin that looked every bit as dead and pale as it had before, but she said nothing. It made no difference what she thought; Doug had convinced himself that the operation was a success, that they’d done exactly what they should have. That everything was going to be fine. In Doug’s world, everything always turned out fine. So be bold, jump out of planes, and let the universe take care of you.
At least the tourniquet was now off. At least he was no longer bleeding.
She rose to her feet, the sour stink of Arlo’s sweat on her clothes. Exhausted by his ordeal, Arlo was now quiet and drifting to sleep. Massaging her aching neck, she went to the window and stared out, relieved to turn her attention to something else, anything else but their patient. “It’s going to be dark in an hour,” she said. “We can’t get out of here now.”
“Not in the Jeep,” said Doug. “Not with that broken tire chain.” She could hear him rattling through all the pill bottles. “We have enough Percocet to keep him comfortable for at least another day. Plus Elaine says she has codeine in her purse, if I can just find it.”
Maura turned from the window. Everyone looked as drained as she felt. Elaine sat slumped against the couch. Doug was staring listlessly at the array of pill bottles. And Grace—Grace had long ago fled the room.
The Rizzoli & Isles Series 11-Book Bundle Page 224