Peril (3 page)

That's unusual. The normal method of strangulation leaves circular ligature marks.

Faint petechial bruises, caused from capillaries rupturing under pressure, dotted the girl's face like freckles.

Except these aren't innocent sun-induced skin blemishes of her youth.

Under her fingertips, Morgan sensed the pulsatile flow of blood rushing by. “Pulse present with compressions. Let's pause to see if CPR helped her out any.”

The nurse stopped. Morgan eyed the transport monitor, noting the still too-slow rhythm. The rate persisted in the twenties—a slow, faint echo of the heartbeat.

She withdrew her hand and turned to pop the lock on the code cart. “All right, continue compressions. Let's get a CPR board underneath her. Eric—”

The young man's dirty blond hair dropped over his hazel eyes as he pulled open the top drawer that housed the emergency medications. “I'll get the epi and atropine ready. Do we have a weight?”

“We're going by fifty kilos,” the other ER nurse stated.

From the door, Morgan caught sight of a couple she guessed to be mid-thirties, holding on to one another.

The parents. And everything the medical team says is in earshot.

She looked Eric's direction. “After you get those meds ready, let's page the chaplain, too.”

Morgan drew her eyes away from the couple and settled them on her young charge in the middle of the bed. A nurse at the teen's chest rocked up and down to stave off the grim reaper. The girl's brown hair flickered with chunky blond highlights.

The only part of her with color other than the bruising around her neck.

Many nurses thought they could understand the outright terror this girl's parents were feeling at the possibility of losing their child. She doubted they could. Morgan had lived through the death of her infant daughter, and she prayed silently for the coming darkness to stop.

There've been too many deaths. Am I even living?

Morgan grabbed a penlight from her pocket and pulled up the girl's
eyelids. A ring of light brown and dilated black pupils stared vacantly back. She placed the light back into her scrubs and then tucked her blond curls behind her ears.

“Pupils are sluggish. Now, all we need is a—”

Dr. Ayer rushed through the doors. “Is this Zoe Martin? What the hell happened? I thought she was stable in the ER.”

The ER nurse rolled her eyes. “She was.”

There was always contention between units. Generally, all staff disliked who they received patients from and who they had to admit patients to. The ER hated EMS—particularly when they continued to bring patients despite notices for diversion. The ER hated the ICU—particularly when they had open beds but refused to take patients because they didn't have enough staff to care for the children. The PICU hated the ER—particularly when they brought an unstable patient through the doors.

Ayer yanked his lab coat straight. “Well? Can anyone here offer any insight as to why she's currently coding?”

Morgan eyed the ER nurse and gave her a friendly smile. There was nothing like being in the middle of a critical situation and having a doctor snidely question treatment. Ayer wasn't known for having a soft and fluffy side.

“She dropped her heart rate on the way up here.”

“Stop compressions. Let's see what we have,” Ayer ordered.

The nurse raised her hands in the air like someone held at gunpoint. Ayer had a gift of making the most seasoned nurses feel incompetent by the constant scowl on his face. The residents hated rounding with him.

He nodded after examining the rhythm. “Is there a pulse present?”

The nurse with the raised hands reached down to check. “Yes, still has a pulse.”

Ayer circled a pointed index finger back at the patient. “Resume compressions.” He eyed Eric with the ready syringe of epinephrine. “You weren't going to administer that without a doctor's order, were you?”

Eric shook his head. “No, sir.”

“Because that would be outside your scope of practice. Looking to get fired after being here only a few short months?”

“Absolutely not, sir.”

Morgan clenched her hands at her sides.

Why did he insist on doing this now? A Napoleon complex?

A good ICU nurse always anticipated what the patient needed so it was ready as soon as the doctor asked for it. How would Eric feel during the next code? Would he wait to draw up the med until it was ordered, delaying lifesaving treatment for the patient because of today's public chastising?

“Let's get her loaded with epi,” Ayer ordered.

Eric approached the bedside and began tracing the line from the main IV bag down to the patient's hand, where he injected the drug.

Ayer cleared his throat and rocked onto his heels, which generally meant he was gearing up for an academic lecture. Even in the absence of a resident to enjoy the lesson, Ayer couldn't help but test those around him with his wealth of knowledge and their lack thereof.

“This patient presented to the ER as the presumed victim of strangulation, correct, Morgan?”

Morgan's heart thundered in her chest.

Can I not have one free moment to stabilize a patient without getting lectured?

Then again, Ayer had two full minutes to torture them before the next decision could be made regarding the patient's treatment.

“Yes,” she answered.

“Anyone know her downtime?” Ayers asked.

Another ER nurse shook her head. “We can only guess. She was found by a couple and a group of Boy Scouts. They state they saw a man running off. She didn't have a pulse when they found her, but they felt that they had interrupted the attack so attempted to save her life.”

Ayer's eyes narrowed. “My report from the ER doc stated she did have a pulse when she hit the ER.”

“Yes, sir. She did,” another ER nurse affirmed.

“So our fine, trusty citizens saved her life enough to put her in a vegetative state for the remainder of it. Morgan, what do you think our overall problem is?”

Morgan's vision hazed. An iron fist of grief constricted her heart. The team continued to do compressions. In the emergency department, they'd already intubated and the ER respiratory therapist now provided the necessary ventilations.

Why today of all days? Another child dying, exactly one month after my daughter's death. Is nothing sacred, God? Please spare me from having to witness another parent's grief. Please.

“I'll go make that call for the chaplain.” Eric handed her three syringes—one more epinephrine, one atropine, and a syringe full of flush solution. Both meds were designed to help increase the heart rate.

Normally PICU staff wouldn't prohibit parents from watching them code their child. It often helped provide closure for families if they could see every effort made to save their loved one's life. However, in Morgan's experience, it was most beneficial when another person separate from the medical staff could explain what was happening at the bedside.

Most units overhead-paged their code events, which prompted the in-house chaplain's response. However, a couple of units managed their own codes without paging overhead—the ICUs being some of those units.

“Morgan!” Ayer shouted.

She jumped. A headache brewed behind her eyes, and she gritted her teeth against Ayer's insolence. Her mind offered many words she refused to say out loud.

Ayer took a step away from her. Still, her glare wasn't enough for him to fly off his perch and abandon the point he wanted to make.

His superiority over everyone else.

He glowered at her. “What is Zoe's problem? Why is she trying to die today?”

Besides the man who held his thumbs over her neck to deprive her brain of oxygen?

Morgan placed her heels together, shoulders straight, before she fired the heavy iron ball directly into Ayer's head.

Lowering her voice, she said, “Dr. Ayer. Zoe is likely suffering from the onset of rapidly progressing cerebral edema caused from the anoxic injury at the hands of her attacker. This is why her heartbeat is slow. She is exhibiting Cushing's triad, which is high blood pressure, widened pulse pressure, and bradycardia. This signals that her brain no longer is in its happy place and is at risk of being shoved into her spinal cord and therefore complicating her situation further, as it could lead to brain death. I would suggest that we load the patient with mannitol to combat the swelling in hopes that pulling off extra fluid will reduce the pressure. And if it is her brain causing the slow pulse, it should respond by increasing. Can I draw that medication up for you, doctor?”

Don't. Mess. With. Me.

Morgan fought the urge to keep her fingers from snapping in his face.
Lucy gave her a wink and the slight shake of her head in lieu of a sassy retort of her own. For several seconds Ayer looked at her blankly as if he'd stroked.

“Two minutes of CPR. Should we check a rhythm?” The ER nurse stopped compressions again.

Ayer checked the monitor. “Pulse with that?” The nurse gave a thumbs-up. “All right. Since it remains low, let's give a dose of atropine and load the patient with mannitol. Continue CPR.” He nodded curtly at Morgan. “Nice work, Ms. Adams.”

Morgan handed off the atropine to another nurse and left the bedside to grab the mannitol when the man whom she assumed was a police detective grabbed her elbow. His brown eyes were nearly the same shade of his slightly curly locks. “How's it looking?”

She glanced at the hallway. The chaplain still hadn't arrived. How could she offer any response with the parents staring at her like she was in fact the angel of death?

Chapter 2

Early Afternoon, Monday, June 11

D
ETECTIVE
B
RETT
S
AWYER
scanned the trail where the girl's body had been found.

He started from the trailhead and inspected the dirt and grass on either side. His team fanned out behind him like a flock of birds flying in formation, making him the head of the V as they searched the ground for possible clues. He eased up when they neared the site where EMS had revived the young girl.

He believed Zoe's soul had vacated but her heart remained steady and strong, not easily convinced that death might be okay when her brain no longer functioned. That was the trouble with these situations. At least that's what the medical team told him in their fancy medical terms.
Anoxic brain injury
. He'd written it down. Had asked that PICU nurse, Morgan Adams, to spell it out for him. What he intellectually understood was the same thing that emotionally unsettled his spirit.
Zoe Martin is dead. Her body just hasn't figured it out yet
.

“Where's your better half?”

Brett glanced off the side of the trail. A uniformed officer, Trace Rutledge, motioned him to his position. He angled that direction.

“Detective Long is working with SWAT today,” Brett said.

“Finally got tired of you?”

Brett cracked his best Joker smile. If he dyed his brown hair green, applied the white, pasty clown makeup and voluminous red lipstick, he might be able to make some cash on the side. Though no one in Colorado would ever hire him. James Holmes had ruined that possible side job after allegedly shooting up a local theater.

“My charm, of course, is too brilliant even for my suave, germ-freak companion. He never tires of it.”

“Come on, admit it, Sawyer. You'll miss him if he switches to that full time.”

Though he'd never confess it publicly, Brett didn't relish having to train a new partner to understand all his idiosyncrasies. He was like beer to a fine wine connoisseur . . . it took a while to develop that sense of taste. And he doubted there were many out there who would understand Detective Nathan Long and all of his oddities. That man could stock Office Depot if they ever ran short of highlighters.

They were two peas in a proverbial pod.

“He'll realize those SWAT guys are too by-the-book even for him. Got something?”

“I think we found his hidey hole.”

Brett glanced to the left where paramedics had left remnants of torn gauze packages and resuscitation equipment littered on the other side of the path. EMS seemed to have done their best to contaminate his crime scene.

Might as well call them the evidence eradication team.

Of course, he knew they believed knuckle draggers like him couldn't possibly understand the importance of saving a life in lieu of preserving evidence. It's just that, when their efforts failed, families looked to him for resolution and what if they'd disintegrated something that could break his case?
No easy answers to that one, I guess
.

There were also a couple of patches of vomit a few paces away on the blacktop.
Guess that's where a few Boy Scouts discovered that fiction and reality aren't quite the same after all. Their little stomachs couldn't handle it
. He scanned the ground as he walked toward Trace.
Hard to tell the difference between new and old trampling
. This is when he could use one of those squirrelly, old-Western mountain men to help him track the killer.