Outside the open window, the night was silent. If she listened very hard she might hear some distant sound—a freight train chugging along the river, a coyote or two calling for the pack, a branch falling from the big pines that bordered the parking lot behind the empty store beneath her apartment. Not tonight, though. The night was as empty as her dreamless sleep had been.

Her cell phone emitted a series of staccato beeps, the closest approximation she’d been able to get to her field radio, the familiarity an odd comfort. She reached for it with a quick easing of the heaviness in her chest.

“Archer.”

“Hey, Glenn.” Cindy Ames’s soft voice was instantly recognizable. Cindy was the head night nurse in the ER, and she and Glenn had spent many hours working together over the last three years. “I’m really sorry to wake you up.”

“No problem. I was awake.”

Cindy laughed briefly. “If you were, I hope you’re doing something fun. But I’m in a jam and I know you’re not on call for surgery anymore, but—”

“That doesn’t matter.” Phone to her ear, Glenn slid naked from beneath the sheet and pulled scrub pants from the neat pile she’d left on the straight-backed wooden chair next to her bed. She’d planned to wear them her first day on the job as director of the physician assistant program in the morning. “What’s going on?”

“Flann’s in the OR with Pete doing a blocked A-V shunt, and I can’t reach Dr. Williams. He’s backup for surgery tonight. I’ve got a lady here whose foot looks really bad. I’d wait for Flann, but—”

“I’ll come over and take a look. Be there in ten minutes. Did you get X-rays?”

“Yeah, I did, and something is weird.”

“Okay, you know what to do until I get there.”

“You’re a savior,” Cindy said.

“Yeah,” Glenn said flatly as Cindy rang off.

A savior.

Nothing could be further from the truth. For an instant, the tally of the dead rolled through her mind along with the memory of acid smoke and the copper taste of blood and fear in her throat. Too many to count, too many without names. But the faces never faded even though she’d taught herself not to let them haunt her, just as she’d taught herself not to dream. But some things could never be erased, not when they were tattooed into your bone and chiseled onto your soul. The dead were as much a part of her as her beating heart.

But not tonight. Tonight she tended the living.

She scooped up her keys, wallet, and phone and let the screen door click shut behind her on her way out. She didn’t bother to lock up—there wasn’t anything inside worth stealing. Her footsteps on the wooden staircase spiraling down the back of the building to the parking lot followed her like so many ghosts. Her ragtop Wrangler was the only vehicle in the tiny lot behind the consignment shop and its neighbors on either side, the pizza place and an antique store. Ordinarily she’d walk the mile up the hill to the Rivers where it looked down over the town and the valley like a conscience reminding everyone that life was fleeting and fickle. But Cindy was an experienced nurse, and if something about this patient bothered her enough to call for help rather than wait the hour or two for Flann or the PA to be available, then she might not have the luxury of the fifteen-minute walk. Instead, she was pulling around to the staff lot in less than five.

The ER would be empty at this time of night, unless somewhere on a nearby highway a thrill-riding teenager had misjudged a curve or a farmer had another case of indigestion that wouldn’t let him breathe or a baby decided to exit the comfort and safety of the womb. But the only vehicles in the lot adjacent to the emergency entrance were those of the staff and an idling sheriff’s patrol car whose occupant was probably inside scoring a cup of almost-fresh coffee. When she pushed through the big double doors into the wide, tiled corridor leading past reception, the bright lights shocked every sense sharply online. Her head cleared of memories and misgivings, and her vision snapped into crystal focus. Somewhere around the corner an elevator door clanked open, a power floor polisher whirred, and someone laughed. In the empty waiting area, a weather map scrolled across the TV screen, tracking tornados in a part of the country she’d never visited and doubted she’d ever see.

Cindy looked up at the sound of footsteps, relief erasing the lines of tension above her bright blue eyes. She must have been in her early thirties, but her creamy complexion could’ve been that of a twenty-year-old. “I owe you.”

“You sure do,” Glenn said. “Half a dozen of those chocolate chip cookies—the ones with the nuts—ought to do it.”

Cindy laughed and pushed blond hair away from her face. A small diamond and accompanying gold band glinted on her left hand. “Then you’re in luck, because I promised the kids I’d bake tomorrow.”

“What have you got?” Glenn leaned an elbow on the high counter that sectioned off the work area from the rest of the ER. The whiteboard on the wall to her right was divided into rows, each with a number indicating the patient room and the names of those who occupied it. Only one was filled in, number seven. Down the left-hand side someone had printed the names of the doctors on call in black block letters. She scanned it, suppressing a grunt when she saw Williams next to surgery backup. He was notoriously unreliable, often taking hours to answer his pages and, even when he did, reluctant to come in. More often than not when she’d been taking first call in the ER and had a patient who needed to go to the OR, she’d call Flann. Flannery Rivers never complained about taking an emergency, whether she was technically on call or not. Williams would bitch and gripe if he had to get out of his warm bed in the upscale Saratoga suburb and drive down to take care of someone who might die if he didn’t come. On the other hand, he never complained if he happened to hear that an emergency had come through that Flann had handled instead of him, as if it was his due that other people make his life easier.

She let go of the pulse of anger. He was an ass and not worth her time. Since returning to civilian life, she’d mostly shed the reflex need to keep everyone around her on track and doing their jobs. All she could do was give every case her best. That would have to be enough. She told herself that a dozen times a day, and someday she might even believe it.

Glenn focused on the vital signs and brief history recorded on the ER intake sheet Cindy handed her.

“Naomi Purcell,” Cindy recapped as Glenn read. “Thirty-five years old and healthy. Married, three kids. They have a small herd of dairy cows down on Route 4 by the river. She came in with a fever and an infection in her left lower leg. It seems she got tangled up in some old barbed wire pulling a calf out of the brush this morning. Now her leg is red and hot and tender.”

“Is she diabetic?”

“No—not that she knows of. I sent off bloods and don’t have them back yet. But her temp is a hundred and three and the wound looks nasty. Swollen and draining.”

On the surface it sounded like a virulent cellulitis, but Cindy wouldn’t have called her for a straightforward infection. She’d have called one of the medical doctors for antibiotics and possible admission.

“What else?” Glenn asked.

Cindy shook her head, her eyes troubled. “She just looks really sick, Glenn—a lot sicker than something like a fairly superficial trauma should account for. And there’s a lot of swelling. I was afraid something might’ve gotten in there that she didn’t realize, some kind of foreign body, so I sent her to X-ray.”

“You know,” Glenn said, impressed as always by Cindy’s clinical sense, “there’s an opening in the rotation for first-year PAs. You might consider—”

“No way. I’m done with school, even if I do have an in with the new program director.”

The title still felt like a too-tight shoe, and Glenn shrugged aside thoughts of her new job. “Where are the X-rays?”

“I put them on a box outside her room.”

“Okay, I’ll check her out. Let me know as soon as you get her labs back.”

“I’ll call now.” Just as Cindy reached for the phone, the red triage phone rang. Cindy gave a little shrug and picked that one up instead. “ACH—go ahead.”

Glenn walked down to cubicle seven and announced herself as she pulled the curtain aside. “Ms. Purcell? I’m Glenn Archer, one of the surgical PAs.”

Naomi Purcell sat propped up on several pillows, her eyes fever bright in a pale white face. Lank strands of medium brown hair framed her face. Sweat beaded on her forehead, and her chest beneath the shapeless cotton hospital gown fluttered with quick, shallow breaths. A tall, husky man in a faded T-shirt hanging over the top of baggy blue jeans stood to the left side of the bed, his hand on her shoulder and terror in his eyes.

“She seems to be getting sicker really fast, Doc,” he said in a low, tight voice.

“I’m fine, Todd.” Naomi Purcell’s voice was wispy and faint but she mustered a smile. “My leg feels like a nest of fire ants are having a picnic on it, though.”

“Let me take a look.” Glenn snapped on gloves and drew back the sheet, expecting to see the angry laceration Cindy had noted on the chart along with the bright red sheen of a superficial infection surrounding it. All the expected signs of infection were there, but nothing about Naomi Purcell’s leg was typical. An irregular inch-long gash just above her left ankle gaped open, and a thin milky fluid oozed from its edges, slowly trickling down onto the sheet. Her foot was swollen to twice its size, the skin thin and tight as if trying to prevent the flesh and fluid beneath from bursting out and close to losing the battle. She checked for the dorsal pulse and couldn’t find it. “Can you feel me touch you?”

“Yes, a little. My toes are numb, though.”

“Do they feel cold?”

“No. More like they’re just not there.”

The inflammation extended up her calf following the path of lymphatic drainage, spidery fingers spreading toxins and whatever bacteria had invaded the deeper tissues. Glenn felt for the artery behind Naomi’s knee and found the rapid beat that signaled Naomi’s system was working hard to combat the infection. “This might hurt a little bit.”

“Don’t worry about me,” Naomi said, as if Glenn had anything else to worry about.

Right now, Naomi Purcell was the only thing that mattered in her life. She gently probed at a distance from the laceration, and a faint crackle, like air popping in the plastic bubble things they wrapped around packages that come in the mail, crinkled beneath her fingertips. Her belly tightened and she straightened up. “I want to check your X-rays. I’ll be right back.”

“She should get some antibiotics, right, Doc?” Naomi’s husband Todd said.

“Yes, and we’ll get on that in just a minute.”

His eyes followed her out of the room. Eyes that said, Don’t leave us. Help us. Eyes she’d seen hundreds of times before. Three X-rays hung on the light box next to the curtained cubicle. The bones of the lower leg stood out like bleached driftwood, balloon-shaped shadows marking the surrounding muscles and fat. And there in the depths of the tissue, clear streaks like icing in a layer cake extended from the edges of the laceration. Air where there shouldn’t be any. She found Cindy drinking a cup of coffee and making notes in a stack of charts in the tiny staff lounge. “We need to start her on antibiotics—I’ll get cultures and call Flann.”

“It’s bad, isn’t it?”

“It’s necrotizing fasciitis, and she needs to go to the OR, right now. I should call Williams, but Flann’s upstairs—”

“God, don’t call Williams. If you do, she’ll be sitting down here until after he’s had his morning coffee.”

“You did good calling me.”

“I knew you’d come. You always do.”

Of course she did, what else would she be doing. She scribbled an order for an antibiotic cocktail and called up to the OR. Dave Pearson, an OR tech, answered. “Hey, Dave, it’s Glenn. Can you patch me into Flann’s room?”

“Sure, hold on. You got something?”

“Yeah—do you have another team?”

“We can put something together if it can’t wait until Flann is done.”

“Let’s see what she says.”

A second later the line buzzed and a woman answered. “OR seven.”

“Fay, it’s Glenn Archer. Can Flann talk?”

“Hold on a second…Flann, it’s Glenn. Can you talk?”

“Glenn?” Flann said. “What are you doing? I thought you’d moved on to greener pastures.”

“Not until seven a.m. I’m down in the ER. Cindy called me. There’s a thirty-five-year-old woman here with necrotizing fasciitis of her left lower extremity. Right now it’s in the midcalf, but the wound is less than twenty-four hours old, and she looks toxic. She needs to come up.”