Lunch. Then back to work. Just as she dropped the chart into the outbox at the nurses’ station, Antonelli stormed around the corner as if leading an assault on some enemy encampment, his usual pace, and flagged her down. She wasn’t actually assigned to him as a supervisor, but for whatever reason, he’d decided she was his go-to person. She didn’t mind, she liked teaching.

He loomed over her, two hundred twenty pounds of barely constrained muscle and testosterone to her one twenty. “Hey, Mari, I’ve got a hot appy that needs to go up to the OR. I’m going to call the surgeon, okay?”

“Whoa, take five there, soldier.”

“Marine.” His tone suggested high insult.

“Okay, marine.” Mari gestured to an out-of-the-way corner where they could talk without patients overhearing them. “Run it down for me.”

He looked annoyed, his dark brows lowering for an instant, but he followed her out of the way of hall traffic. Although he was impatient and cocky, he respected the chain of command, and she respected him for that. He was smart, maybe the smartest of the bunch, but he was quick on the draw, a result undoubtedly of his military experience. She refrained from reminding him this wasn’t the battlefield, and every decision didn’t have to be made between one heartbeat and the next. She didn’t discount his field experience and what he had learned from it, but a civilian ER was a different kind of battlefield, and sometimes, careful surveillance and planning was just as important as the ability to rapidly assess and respond.

“It’s textbook,” Antonelli said in his usual confident and moderately dismissive voice as soon as they were alone. “Twenty-five-year-old female, twelve hours of progressively increasing right lower-quadrant pain, nausea, low-grade temp.”

“White count?” Mari asked.

“Ten point five.”

“Just mildly elevated,” Mari pointed out.

He lifted a shoulder. “It’ll be a lot higher in a few hours if she doesn’t get that out.”

“Pregnancy test?”

“Pending.”

“Heterosexual, sexually active?”

“Yeah. Straight, no chance she can be pregnant.”

“Not sexually active, then?”

“No…I mean, yeah, she is,” Antonelli said, his tone suggesting this line of questioning was annoying at best, “but she had a period a month ago, and they always use a happy hat…condom.”

“Normal?”

“Huh?”

Mari almost smiled. One thing the military didn’t teach medics particularly well was female healthcare. Female troops on the front lines lived with men, fought with men, and were considered one of guys in almost all ways—but they were still biologically unique. “Was her period typical for her—timing, duration, amount? Did you ask?”

“No, she said—”

“Come on, let’s go ask her.”

“Listen, can’t we call surgery and at least get them down—”

“Why don’t we make sure we have the full story so we get the right person down here.”

As Mari walked back to the cubicle with Antonelli dogging her heels, she scanned the chart and didn’t find anything else that teased her antennae. Antonelli was probably right. The most obvious diagnosis was usually the correct one. She smiled when she thought of the old adage, When you hear hoofbeats in the hall, don’t think of zebras. All the same, the difference between a good diagnostician and an excellent one was both curiosity and suspicion. Probably a little OCD as well. The time to be certain was before you acted, because once you began a course of treatment, uncertainty was the enemy, especially if the treatment happened to be surgical.

She pulled back the curtain and introduced herself to the pale young Asian woman who waited alone in the cubicle. She briefly ran down the history Antonelli had already taken and noted one thing he hadn’t.

“So your last period was a little late and shorter than usual?”

“Only a day and not much of that,” the patient said. “But I was right in the middle of some pretty intense rehearsals, and a lot of times when I’m really stressed that happens.”

“What do you do?” Mari asked.

“I’m a dancer. Modern, mostly.”

“Where do you perform?” Mari couldn’t imagine a local art house in this rural area, and even if there was one, she doubted it could support a dance troupe, but maybe the company was located in Albany.

Kuni Yamaguchi smiled. “We’re performing at the Saratoga Performing Arts Center this summer. I’m with the New York Dance Company, but my grandmother lives here. I stay with her whenever I can.”

“Wow, that’s incredible. I’ll have to check out the events calendar.” Mari drew the sheet down and gently palpated Kuni’s abdomen. When she reached the lower right quadrant, the young woman tensed and caught her breath. “So tell me about this pain.”

“I didn’t really pay any attention to it until last night, and then it just wouldn’t go away.”

Mari recalled Antonelli’s history and physical. Twelve-hour history of pain. “It didn’t actually start last night?”

“Well, it didn’t really start bothering me until last night. I noticed it just a time or two over the last few days. Not enough to slow me down. I didn’t miss rehearsal.”

“Aha. I know how that is.” From what Mari knew of dancers, most women in competitive fields, really, they’d have to be dead to miss a rehearsal or class or meeting. She glanced over at Antonelli, whose impatient expression had turned to a frown.

“What do you say we get an ultrasound in here,” Mari suggested casually.

“Yeah, I copy that.”

Turning back to Kuni, she said, “I want to do a quick ultrasound scan, that’s a test—”

“I know what it is, but why? The other doctor thought it was my appendix.”

“And he might very well be right. But sometimes two different things can look a lot alike at first. I just want to be sure that we’re not talking about something to do with your ovaries. We can do it while we’re waiting for the results of your pregnancy test.”

“Oh.” For an instant, Kuni looked panicked. “I can’t possibly be pregnant. I don’t have any time to be pregnant, and besides that, we’re always really careful.”

“You take the Pill?”

“I did, but it makes me bloat so I stopped. But I use a diaphragm and we use a condom.” She laughed. “Really, nothing could get through all that.”

“Uh-huh,” Mari said, seeing no point in citing the statistics.

A second later Antonelli pushed the curtain aside and trundled in with the portable ultrasound machine. He set it up beside the bed and glanced at Mari.

“Have you done one before?” Mari asked.

“A couple of times.”

“Good. Let’s see what we see.”

He squeezed the cold blue gel onto Kuni’s stomach and she stiffened at the first contact, then relaxed as Antonelli, with surprisingly sensitive hands, gently guided the probe in ever increasing circles from a spot in the right lower quadrant outward. At one point he paused, backed up, and circled again. He stopped and looked over at Mari. She had been following the images on the screen, and the mass in the right lower quadrant was pretty hard to miss.

“Let’s get GYN down here,” Mari said, looking directly into Antonelli’s eyes to make sure they were on the same wavelength. The bright snap in his dark gaze told her they were and he would make sure to request a consult stat.

Mari covered Kuni with the sheet as Antonelli stepped out to call GYN. “Did someone come with you today?”

“No, I didn’t want to worry my grandmother until I knew what was going on.”

“What about your boyfriend?”

For the first time, the young woman, who had to be in considerable pain, looked distressed. “He, uh, no. I’d rather not…”

“You might want to call him or a family member,” Mari said. “We’re going to get one of the GYN surgeons down here, but I’m pretty sure you have what we call an ectopic pregnancy. That’s a situation where a fertilized egg doesn’t make it into the uterus but lodges somewhere else—often on a fallopian tube.”

“Pregnant? That’s not possible.” Kuni’s strident tone suggested she didn’t want to believe it, but a note of uncertainty flashed across her face.

“There isn’t a contraceptive in the world that’s a hundred percent, although some are obviously better than others. And if there was a time that maybe the condom slipped off or he didn’t get it on until later than usual…?”

“I don’t know, maybe that could have happened.” Kuni passed a trembling hand over her face. “God, what a mess. If it’s what you think, will I need surgery?”

“Yes, and the gynecologist will discuss all those details with you. Is there someone I can call for you?”

“My grandmother, I guess, but can you try not to worry her? She’s tough as nails, but she’s still eighty.”

“Of course. And you’re sure no one else?”

“He’s…our relationship isn’t public.”

Mari nodded. As long as she could find someone to be there to support the patient, the nature of her personal relationship was not her business. “All right. If you change your mind and want me to call him, I can. Do we have your grandmother’s number?”

“Yes, I gave that to the receptionist as next of kin.”

“I’ll be right back.” Mari squeezed the young woman’s hand and left to make the call.

By the time she was finished and assured Kuni’s grandmother she had enough time to arrange for someone to get over to the house to look after her animals, the GYN attending, of all people, was in the cubicle. She’d expected a resident, as had been the norm at the LA medical center where she’d trained, but then she remembered that most of the departments here didn’t have a residency program. Yet. Many of the doctors worked with nurse practitioners or physician assistants instead, but the staff physicians often answered their own ER calls out of necessity and expediency.

The gynecologist, a rugged middle-aged man with thick brown hair, a lantern jaw, and an incongruously soft, melodious voice, was in the midst of repeating the ultrasound when Mari walked back in.

“What I’m seeing here,” he said in his soothing baritone, “is a mass about the size of an orange sitting on your right fallopian tube that shouldn’t be there. That’s probably where the egg attached itself and is now bleeding.”

“It’s not my appendix?”

“Definitely not. We need to go in and remove what shouldn’t be there and stop the bleeding.”

“When?”

He set the probe aside and gently wiped the ultrasound jelly from her abdomen with a cotton four-by-four. “Right now.”

She caught her breath. “Can I wait for my grandmother so we can talk it over?”

“We’ll get the operating room ready, but this isn’t something that can wait too long, and surgery isn’t optional. If this bursts, the bleeding will pick up quite a bit.” He didn’t mention that catastrophic hemorrhage was a possibility or that ruptured ectopic pregnancies could be lethal. He smiled, but his expression was uncompromising. “So we’ll wait as long as we can.”

Mari said, “Your grandmother should be here any minute, Kuni. She was leaving as soon as she made a phone call.”

Kuni nodded and closed her eyes in acceptance or defeat, or probably a little of both.

Mari, Antonelli, and the GYN attending all stepped outside, and the attending, whose name tag read Brian Brownell, MD, looked at Antonelli and said, “Good pickup.”

“Mari’s call, not mine.” Antonelli scowled. “I would’ve missed it. Thought it was appendicitis.”

“Yeah, they can look a lot alike.” Brownell clapped him on the shoulder. “But you won’t miss it next time, will you?”

“Damn right,” Antonelli muttered. Brownell sauntered off to make arrangements with the OR, and Antonelli grimaced at Mari. “Fuck me. I blew that.”

“How many women with noncombat injuries did you treat over there?”

“I was assigned to a forward operating base, meaning pretty much no one we got had anything but combat trauma.”

“Then I wouldn’t be too hard on myself.”

“Yeah.” He glanced down the hall, as if seeing someone even though the way was empty. “Bet Archer would have picked it up first time, and she was frontline, closer than me even.”

“How do you know that?” Mari didn’t want to imagine Glenn in the midst of a firefight or in a jumble of bombed vehicles, trying to save lives while her own could end at any second. She didn’t want to see it, but she could, and her stomach protested.

“I asked her.” He shrugged. “And she’s got the look. Anyhow, thanks for the backup.”

“Anytime.”

Mari checked the board—as clear as it had been all day—and the clock. Another hour had passed since last time she checked, and if she didn’t eat before the midafternoon rush when people finally decided that whatever had been keeping them up the night before or bothering them all day couldn’t wait another hour rolled in, she’d never get food. Maybe Glenn would be free. “Hey, Nancy, have you seen Glenn?”