Warning Signs

by C. J. Lyons

  “Hang on. Help’s coming.”

  Through the fence, Nora saw the ER’s doors open across the street, releasing two figures pushing a gurney laden with equipment. A man dressed in surgical scrubs sprinted past them, a blue blur as he bolted across Mathilda Street, almost getting hit by a car. Seth Cochran. Lord, couldn’t it have been anyone else?

  “You’d better call the police,” Nora told Lydia, wrapping her free hand around the woman’s wrist—the only comfort she could offer until help arrived.

  “Already on it. We’ll have Trauma One ready and waiting for you.”

  Nora squeezed her cell phone so hard it almost slipped away. Before hanging up, she added, “Lydia. She’s going to need a rape kit.”

  “Nora!” Seth called from five graves away, startling a solitary bird from the holly bushes. He was too loud for this place. That was Seth, always somehow larger than life—too alive, too vibrant, too… much. “Are you all right?”

  Of course she was all right. She was always all right. Even as she knelt in wet grass, hands covered in sticky neon paint and another woman’s blood, her insides churning, bile clawing its way up her throat, Nora was all right. She had to be. It was her job.

  “Multiple stab wounds, she’s shocky, blunt trauma.” Nora reported as she concentrated on the woman’s pulse fluttering beneath her fingertips.

  “What the hell?” He skidded to a stop beside her, kneeling at the woman’s head. “Help me turn her over. Watch her c-spine.”

  Elise Avery, one of the flight nurses, ran to joint them, bringing with her a paramedic, a stretcher, and a backboard. Seth cradled the woman’s head in his large hands, supporting her cervical spine as they rolled her onto the backboard. The woman now lay face up, the extent of her injuries revealed.

  “My God,” Elise said as she fastened the c-collar. “It’s Karen Chisholm.”

  Seth’s face blanched the same chalky white as the tombstone beside him. Karen was a nurse anesthetist as Angels. She was also the reason Nora and Seth had split up five months ago, after Nora discovered Karen and Seth naked together in a hospital call room.

  But she couldn’t think of any of that now. Now Karen was a patient. Her patient. Nora’s fists tightened with the effort as she clamped down on her emotions.

  “Get the O2 on her,” she ordered.

  Seth listened with his stethoscope. His hands shook. Anyone except Nora would think it was from the cold.

  “Left lung is down, heart sounds distant,” Seth pronounced, his voice grim as he palpated Karen’s naked torso, ignoring the graffiti and blood. “I need to crack her chest.”

  They maneuvered the backboard onto he stretcher. “I lost her pulse,” Nora announced, starting CPR. Elise grabbed a bag to force oxygen into Karen’s lungs.

  “Call the ER,” Seth ordered the EMT as they pushed the gurney over the grave sites and bounced back onto the pavement. “We’re going to flash and crash. Tell them to get the OR ready.”

  “Room thirteen?” Elise asked, now jogging beside the gurney as traffic stopped to let them cross the street. “Not upstairs?”

  Seth was shaking his head. “She won’t make it upstairs alive. Room thirteen is our only choice.”

  “Not much of a choice,” Nora replied. The small but well-stocked operating room behind the ER was used only for patients too unstable to survive the short elevator ride upstairs to the main operating rooms on the fourth floor. Most OR 13 patients died.

  They pushed past the ER’s doors and raced down the hallway. Ahead of them two night-shift nurse were scrambling, getting the lights on in Room 13 and unpacking sterile instrument trays.

  “Anesthesia and the trauma team are paged,” Lydia Fiore, the ER attending on duty, said when they banged through the operating room’s doors.

  Nora continued CPR. Elise prepped the patient, throwing some drapes over Nora’s hands splashing her with Betadine, while Lydia intubated and hooked up a ventilator and monitor.

  “C’mon, people, let’s hustle.” Seth snapped on gloves, not bothering with a gown or mask as he grabbed a ten blade and sliced open the left side of Karen’s chest. Dark maroon blood splashed him, puddling at his feet.

  Golden-brown Betadine soap swirled around the neon glare of the spray paint, not hiding the hateful words so much as highlighting them. Nora threw on gloves, their bright purple color clashing with the graffiti punctuated by dozens of stab wounds across Karen’s chest and abdomen. Nora slid into position beside Seth, grabbing a sponge and a Satinsky clamp.

  “IV’s in, blood on the rapid infuser,” Elise announced.

  “Clamp,” Seth said, holding his hand out blindly. Nora slapped the Satinsky into his palm as she reached in to clear the field with the sponge. “Aorta cross clamped. Someone mark the time.”

  “Five hundred cc’s out of the chest tube already,” Lydia told him. “And her belly’s distended.”

  “One thing at a time,” Seth muttered as he delicately snipped a hole in the bulging membrane surrounding the heart. A gush of blood poured out.

  “I’ve got a pulse.”

  “Good.” Seth straightened, a smile of satisfaction flickering across his face.

  Two surgical nurses rushed in, gowned and scrubbed and looking askance at Nora in her civilian clothing. She stepped aside as Seth dumped more Betadine over Karen’s abdomen. “Okay, let’s get to work on that belly. Knife.”

  The flash of a camera blinded Nora for a moment. Elise lowered the camera. “Sorry.”

  “No, good thinking,” Lydia said as an anesthesia resident took her place at the head of the bed. “Document as much as possible. I have to get back to the ER. Nora, can you do the rape kit?”

  “While you’re at it, I need a Foley,” Seth said, starting a vertical incision that extended from Karen’s chest down to her pubic bone.

  Nora grabbed a sterile gown and wrapped it around her body, then changed her gloves. Elise held Karen’s legs apart to help Nora insert the bladder catheter.

  Seth glanced up, scalpel poised. “Any time now, ladies.”

  “Give her a break,” Elise snapped at him. “He used a knife on her. Everything’s messed up down here.”

  Nora ignored them, instead focusing on the small, intimate space before her. “Foley’s in. Elise, take photos while I start the rape kit.”

  She turned away, shaking her head until the room stopped blurring before her. Small tiny shakes, casting away her feelings so that she could focus.

  The sounds of machinery and the murmur of voices faded into the distance. Blocking out everything around her, Nora carefully collected as much evidence as possible. She swabbed and combed and plucked and dried and labeled and sealed everything into the shoebox-sized evidence kit.

  It was easier to move around the blood and paint and people if she simply denied their existence. A roaring noise commandeered her brain, but her hands continued to function, to do their job of caring for her patient.

  Seth’s hand fell onto her shoulder just as she finished clipping Karen’s fingernails, dropping them into a white envelope and sealing it, scrawling her name across the seal. “Nora, did you hear me?”

  She glanced at his bloody hand on her shoulder. Blinking, she realized the room had gone silent; she and Seth were the only ones remaining. There was no whoosh of the ventilator or beeping of the cardiac monitor. Only the sound of her gown rustling as she straightened.

  “She’s gone,” he said, his voice cracking. He swallowed hard, his gaze darting toward Karen, then ricocheting back to Nora. “I tried everything, but the bastard trashed the vena cava. I couldn’t get her back.”

  He turned his back to her, stripping the gloves from his hands, snapping them into the garbage. His shoulders hunched together as he gripped the edge of the biohazard container
for a long moment before facing her again.

  The neon graffiti desecrating Karen’s body sparked in Nora’s vision. Seth’s scrubs, neck, and face were speckled with blood. His brown hair was long and shaggier than she remembered it—they saw each other every day, but she forced herself not to notice these things that were the purview of a girlfriend, telling herself that he had someone else to take care of him.

  That he didn’t need her. That he had Karen—sexy, skinny Karen with her extensive knowledge of the Kama Sutra. Karen who smiled and laughed all the time and who Nora bet never cried when Seth made love to her, who never freaked out and refused to leave the house without his checking the shadows and holding her hand.

  Karen who lay cold and dead on the table before her.

  God, how Seth must feel, to be the one who lost her, who couldn’t save her…

  Pushing aside her own emotions, Nora looked at him, wanting to help but too numb to know what she could do. She stared at the evidence envelope gripped between her fingers. She still had work to do. For Karen.

  “Nora? Are you all right?” He tilted his head, a heartbreakingly familiar little-boy expression that could mean anything from guilt to concern wrinkling his eyes. “Why don’t you leave that for the police and medical examiner?”

  She dropped her envelope into the evidence kit and reached for the oral swabs.

  “I need to finish.”

  “No. You don’t. C’mon, leave it.”

  She turned her back on him and walked around the table to the head of the bed.

  The drape had been dropped, covering Karen’s once-perfect body. Her once-perfect face was marred by scarlet paint, sprayed across her closed eyes and forehead with the word whore. One eye was swollen and bruised, as were both cheeks. Red marks circled Karen’s neck along with more bruises.

  Nora slipped her fingers between Karen’s jaw and the endotracheal tube, felt the jaw slide sideways, and knew it was broken in at least two places. Seth made a choking noise and turned away.

  Nora collected the swab, resting the fingers of her free hand against Karen’s eyes. Shiny material crusted the lashes, sealing them shut. Superglue. Nora remembered the pain, eyelashes ripping free, corneas abraded.

  Just as she knew the pain of the swollen throat. It was days before her voice had returned to normal; to her colleagues she’d blamed the winter flu bug. She remembered countless showers and baths and hours scrubbing at spray paint with turpentine and mineral spirits, leaving behind red, raw, burning skin.

  And the pain. Not just the bruises and aches and scrapes, but the pain inside, deep inside. The same pain that sometimes returned to haunt her even now, almost three years later.

  “I’m sorry,” she whispered to the dead woman. “I’m so sorry.”

  She stroked Karen’s hair, the once lone, shining tresses now hacked haphazardly as if by a scissors-wielding toddler throwing a tantrum.

  No, not scissors. A kinife. Long, wide, one edge serrated, the other razor sharp.

  “We’re all sorry.” Seth caught her arm, pulling her away from the corpse. “You’re shivering. Come with me; I’m getting you out of here. Lydia never should have asked you to do that rape kit.”

  Nora wrenched away from him. “She didn’t know. I’m the sexual assault examiner on duty. It’s my job.” “Not today. Leave it.”

  She glared at him, then spun on her heel, sealing her evidence kit. Her handwriting was shaky as she finished signing her name. “It’s all my fault.”

  “No. It’s not. There was nothing more you could have done for her.” His voice sounded distant even though his hands held hers tight, pulling her away from the sexual assault kit. The neon graffiti blared through her vision; she couldn’t look away.

  Seth was the only person alive who knew Nora’s secret: that on New Year’s Eve two years ago, long before she’d ever met Seth, she’d been raped. But she hadn’t told Seth everything. Not about what had happened to her, not about what she had done. She’d thought she had left it all behind, had created a new life, one where the rap was a secret buried forever.

  “Who could have done this?” he said, his voice shredded. “A gang—high on crack or meth?”

  Slowly she raised her glance to meet his. “It wasn’t a gang.”

  She glanced at the corpse beside her, sucked in her breath until her chest was tight and there was no room for anything else. She needed to tell him the truth.

  “It was the same man, Seth.” Her voice rang hollow, echoed from the tile walls of the empty OR.

  “What?” He squinted at her as if that would help him hear more clearly. “You mean—” He shook his head violently. “No. It couldn’t—”

  “It was. It is. The same man.”

  Seth stared at Karen’s ravaged body, his face morphing into a mask of horror and confusion. “You—Karen—”

  With his hand clamped to his mouth, he rushed past her, his face splotched with crimson. He raced down the hallway and slammed open the door to the clean holding room.

  Snapping her gloves off and tossing them into the red biohazard bag, Nora started to follow him, but she stopped outside the OR’s doors. She couldn’t leave Karen’s body unattended.

  Miguel from housekeeping turned the corner, whistling as he pushed his cart.

  “Miguel, could you do me a favor? Watch that door, okay?” She barely waited for his nod before she followed Seth’s path to the clean holding room.

  She knocked on the door, opening it without waiting for his response. He was bent over the sink in the corner, heaving up his breakfast. His body shook violently even after he stopped vomiting.

  Nora grabbed a towel from the shelves, ran cool water over it, and wiped his face clean. She let the water run, rinsing the acrid smell away. She didn’t look him in the eyes, but gave him some semblance of privacy as she kept one hand always on his body, ready, waiting.

  Finally he inhaled, straightening as the air filled his body. He pressed his hand against his eyes for a long moment. Then he exhaled, a plaintive whoosh that echoed above the sound of running water. He opened his eyes, met her gaze.

  “Are you all right?” She gave his arm a quick squeeze.

  She immediately let him go, realizing the familiarity was no longer her prerogative. An awkward silence passed between them. She’d never felt awkward around Seth before—furious, sad, irritated, yes, but never this blind, stumbling, knowing-too-much feeling.

  “I’m so sorry,” she tried again, but her words sounded hollow and meaningless.

  She wanted to comfort him, to help, but she didn’t know how. All she could do was stand there, staring, hanging on to a dirty, wet towel instead of reaching for him. He wasn’t tall, only five-ten, but compared to her five-three he’d always felt tall enough. Just right for tiptoe kisses or for him to lift her in his arms. Once upon a time.

  Nora focused all her attention on wringing out the towel. Suddenly the room felt too small for the two of them and everything that lay between them.

  His hand reached out for her, then dropped back to his side, empty. “You said you’d been drinking that night,” he started, then faltered to a stop. “New Year’s. Two years ago.”

  She nodded, concentrating on hanging the towel from the sink’s edge. She turned the water off. Silence fell. She tugged on the hem of the towel, making it line up, perfectly even. “I had a few drinks.”

  “I thought you meant you were both drunk, things went too far—”

  “That I said no, and he heard yes? Just another date rape, nothing too disturbing, right?” Fury colored her words. “And so you didn’t ask any more questions, didn’t need the details since they’d put the blame on me, too drunk to keep a guy’s filthy hands off me. I made it easy for you, didn’t I, Seth? Maybe too easy.”

 
He backed away, banging into a metal shelving unit, sending a stack of suture trays to the floor. “I didn’t—I couldn’t—” His Adam’s apple bobbed as if something sharp and painful were caught in his throat. “Tell me. Tell me what really happened.”

  She was tempted to. But even after everything that had happened between them, she couldn’t. It was bad enough he’d seen Karen’s body, seen the outward evidence. No way would she burden him with more details. Of the fact that Karen had obviously suffered even more than Nora had. The rapist had terrorized Nora with his knife but had never cut her, not like he had Karen.

  “You don’t really need to know all that. What you really need to know is that it’s my fault Karen was killed.” She licked her lips, but it didn’t help; her tongue grated against them like sandpaper. “It’s my fault. Because I never told anyone. Not until I told you.”

  “The police?”

  “No, Seth. I never went to the police. And now I have to face the consequences.” Her vision wavered, but she didn’t sway or fall. She stayed in control, finished her confession.

  “Karen is dead because of me.”

  NOTE TO READERS

  I hope you enjoyed Warning Signs. As with every novel, there are a lot of people I need to thank for their help and support.

  First, my tireless editor at Berkley, Shannon Jamieson Vazquez, and everyone on the Berkley team who helped bring Warning Signs to life. Also, my agent, Anne Hawkins, who always watches out for me, pulling me back from the precipice when I’ve gone too far, and pushing me harder when I need to move out of my comfort zone. And finally, my critique partners: Toni McGee Causey, Kim Howe, Margie Lawson, and Carolyn Males. You guys make writing a pleasure.

  For research, I turned to the experts of Pittsburgh’s River Rescue Team: paramedics David Naples and Anthony Weinmann, as well as hyperbaric nurses Julie Jacob and Georgia Siebenaler, and ER charge nurse/paramedic instructor extraordinaire Laurie Weaver.

  Any deviation from reality is mine, not theirs. If you’d like to see what a real hyperbaric chamber looks like, or the River Rescue crew and their boat, please check out the Adventures in Research article and photos on my website, www.cjlyons.net.