Excerpt of Blood Double by Neil McMahon

Chapter One

Carroll Monks was standing on the spot he thought of as the bridge of Mercy Hospital's emergency room. It was like the command deck of a ship, the point from which he could monitor most of what was going on at any given time: the eight private cubicles, six of which were occupied; the trauma room, which was not; the activities of his resident, nurses, and other staff; the softly bleeping monitors and blinking lights of the complex instruments; and the main desk, where the charge nurse worked at a computer. Monks could glimpse through the glass doors into the waiting room, which held a further group of postulants, most of them in discomfort, none in severe distress. He could hear the ongoing radio report of a team of paramedics in the field, attending to a mild heart attack that did not require his intervention.

This was the way the ER was most of the time, busy but stable - and tensed for whatever might burst through the oors that would throw it into organized frenzy.

It was a damp Tuesday evening in March, 7:07 p.m.

Monks sensed a stir in the waiting room, a tiny ripple of movement that caught his gaze. A woman was coming in. He got an instant impression as she yanked open the door, framed inits light. She was about twenty, pretty, sturdily built, with black hair and golden skin: Asian. Heavily made up, wearing a short black dress. On her own feet, with no obvious injury.

But moving fast. Half-running, on spike heels, to the desk. Speaking urgently to the receptionist, pointing back outside.

The receptionist leaned forward, puzzled.

The Asian woman closed her eyes and quickly placed her palms together beside her tilted face, a child's gesture of sleep. Then she jabbed her finger toward the outside again.

Monks said, “Nurse!” and moved for the door.

The cool wet air of the San Francisco night blurred his eyes, and he squinted to focus in the orange-yellow glow of the parking lot's lights. Twenty yards ahead, a figure lay sprawled on the sidewalk, with another crouched over it. Their faces were touching. Monks felt an instant of eerie terror, the shocking sense that he had stumbled onto an act of desperate passion gone wrong, or even a vampire ripping into its victim's throat.

But then the crouching man's face lifted, and Monks saw one hand pinching the downed man's nostrils, the other positioned behind the neck. This was not violence, it was mouth-to-mouth resuscitation.

Monks turned to yell behind, “I've got an unconscious man, he's not breathing, let's go,” and dropped to his knees beside the sprawled figure. His fingers touched the neck to find the carotid artery's pulse. It was barely detectable. He thumbed an eyelid open and could just make out the blank round iris, the pupil shrunk to a pinpoint. The body was shutting down.

The crouched man, like the woman, was Asian: small, wiry, gaunt-faced. His eyes watched Monks.

“Ovahdose,” he said. His hands moved to make a quick gesture of jabbing a needle into his arm.

The other man was Caucasian, in his late thirties. His face was dirty and abraded, as if from falling. But his shirt was hand-woven, tailored cotton, and his shoes leather loafers that also looked handmade. His teeth were beautifully cared for. This was not the sort of junkie Monks was used to, and his first guess would have been respiratory failure from another cause - except for what the Asian man seemed to be telling him.

Monks said, “Are you sure?”

The Asian shook his head in incomprehension. “Ovahdose,” he said again, and bent back to the mouth-to-mouth. He was quick and efficient, obviously trained; had sustained the fragile hold on life for critical minutes.

Monks decided to believe him.

Monks craned around. Two nurses were coming fast with a gurney, kneeling with the Ambu bag to take over breathing. The Asian man exhaled one last breath into the receiving lungs, then moved out of the way in a crouching roll that made Monks think of a paratrooper's landing fall.

He strode ahead into the ER, calling orders, stepping into gloves and barrier gown. The nurses prepped the patient, putting a rolled towel behind his neck, hooking him to a cardiac monitor, preparing an IV. A respiratory therapist took over the Ambu bag, now hooked to an oxygen source. A third nurse arrived with a clipboard to note procedures and times.

His gaze swept the room. His daughter Stephanie, in her first year of medical school, was working part-time as a hospital attendant. When Monks was on duty, she liked to visit the ER, getting a feel for it. She was standing against a wall, hands clasped like a shy girl waiting to be asked to dance: eager to help, afraid to interfere.

He called to her, “Take over recording.” It would free up the nurse, and give Stephanie a look at why she might want to choose another specialty.

“I'm having trouble breathing for him, Doctor.” The therapist was holding the mask against the patient's face with one hand and squeezing the plastic sack hard with the other, but the lungs were not inflating well. Monks stepped in, pulled the jaw forward, and leaned close to listen. Over the weak breaths came the harsh sound of stridor: vocal cords or tongue had swollen, obstructing the passage.

He said, “Let's get an oral airway in.” He held the mouth open while she inserted the device, a flanged four-inch tube, to allow air past the tongue. He realized he was taking deep breaths himself, that he was unconsciously resisting what was happening, reassuring himself that it was not happening to him. He braced himself for the next step, the insertion of an endotracheal tube. It was a risky procedure...