Chapter One
Christmas 1990
It rained the entire day. It rained with such force that
the shrubs next to the emergency room parking lot lay flat
to the ground and the new roof sprang a leak. One of the
nurses set a bucket on the floor of the waiting room to
catch the water, and within an hour the rain had filled it
to the brim.
Olivia Simon watched the downpour through the broad
windows of her office. The rain sapped her concentration,
and the journal on her desk was still open to the article
she'd started hours before. There was something unnatural
about this rain. It sucked the oxygen from the air and
made it hard to breathe, and it pounded above her head
like marbles falling on a sheet of tin. Just when she
thought she could no longer tolerate the noise, it
stopped. In the silence, Olivia watched the sky turn light
and shiny, like the inside of an eggshell. Then suddenly,
it was snowing.
She walked into the reception area, where Kathy Brash and
Lynn Wilkes had been playing pinochle for the last
abysmally quiet two hours.
"It's snowing," Olivia said.
They lifted their rained-dazed eyes to hers, then turned
their heads toward the windows.
"Unreal." Lynn stood for a better look, her white coat
scraping a few cards from the table.
"It's beginning to be an annual tradition on the Outer
Banks," Kathy said. "Last Christmas we actually got snowed
in."
Olivia looked at her watch. Five-thirty. She couldn't
afford to get stuck here tonight.
Lynn took her seat again. "Want us to deal you in, Olivia?"
Olivia declined, and returned to her office. She couldn't
make herself join them tonight. She was too antsy, too
preoccupied. She needed to get home.
She sat behind her desk and dialed her home number.
"It's snowing," she said when Paul answered.
"Yeah, I know." He sounded irritated. She was getting
accustomed to the curt tone he used with her these
days. "When are you getting out of there?"
"Soon. Just a half hour more." She'd had no choice but to
work today. Of the four emergency room physicians, she had
the least seniority. She wished she could tell Paul that
it had been worth her while coming in today, worth their
being apart when, God knows, they needed the time
together. But all she had seen in eleven long hours was a
scraped knee and a case of severe post-turkey indigestion.
On days like this, she found herself missing the chaos of
Washington General, where she'd worked for the past ten
years, where her seniority had given her some control over
her schedule. It scared her these days, being away from
Paul. When she wasn't close enough to touch him, she was
afraid he might disappear.
They'd spent last Christmas with his family in
Philadelphia. Paul had written a poem about her and
stitched it into a sampler sometime during the long hours
she was at work and he was not. The sampler hung in the
study, and now each time she looked at it she wondered how
the warmth Paul had felt for her one short year ago could
have disintegrated so quickly.
"Turkey's falling off the bone," he said now. "Should I
take it out?"
Olivia started to answer, but just then the Police radio
in the hall outside her office coughed to life.
"Hold on, Paul." She held the receiver away from her ear
and listened as Kathy sat down in front of the radio.
"Kill Devil Hills Emergency Room," Kathy said.
"We've got a gunshot wound to the chest." A male voice
broke through the static. "Female. Mid to late thirties.
Pulse one-fifty and thready. B.P. seventy-five over forty."
"What's your ETA?" Kathy asked.
"Fifteen minutes. Maybe twenty. It's fucking snowing out
here."
Olivia stood up. "Paul, I've got to go." She hung up the
phone and raced to the treatment room. "Call Jonathan '"
she said as she passed Kathy. Jonathan Cramer was not
Olivia's favorite physician to work with, but he was the
back-up physician tonight and he lived closest. He could
be here in seconds.
She was soaping her hands and wrists at the treatment room
sink when Jonathan arrived. "Gunshot, huh?" he said as he
rolled his shirt sleeves over his beefy forearms. "We'll
stabilize her and fly her up to Emerson."
Olivia turned on the EKG monitor. "We haven't even seen
her yet."
"She's going to need a trauma unit."
Olivia began setting up the intubation tray. Jonathan had
last worked in a sleepy Louisiana hospital. Gunshot wounds
were probably not his area of greatest confidence. He had
been here a little over a year, the first physician hired
by the new free-standing emergency room, the only
emergency facility serving North Carolina's Outer Banks.
She'd been told she'd be on an equal plane with him, with
equal say in all decisions made. Yet she often wondered if
some
e had neglected to pass that information on to Jonathan.
"Let's see her first," she said.
They had the treatment room ready by the time the two
paramedics wheeled the woman into the ER. Her shirt and
bra had been cut off. The bullet hole in her left breast
was deceptively small and bloodless. That could mean only
one thing — the bullet had penetrated the heart. Olivia
felt a rush of adrenaline. Surgery was the only possible
course of action and they had no time to waste.
"Get the surgical tray," she said to Kathy.
"What? " Jonathan was helping one of the paramedics fit
the inflatable MAST trousers on the woman's legs. "Forget
it, Olivia. Let's get her out of here and up to Emerson."
"Get me two units of O-negative packed cells," she said to
Lynn as she checked the woman's vital signs. It would take
the helicopter forty minutes to fly her to Emerson,
probably longer in the snow, and at least another fifteen
minutes before she could get into surgery.
"She won't make it," she said.
Kathy produced the surgical tray. The instruments rattled
against one another in her trembling hands. She had pinned
her dark hair up, and Olivia wished she'd thought to do
the same. Her fine brown hair was a little longer than
chin-length, and each time she lowered her head it slipped
forward, like blinders.
"You can't be serious," Jonathan said. "We're not set up
for anything like this."
"Fifty over thirty," Lynn said. "I can't get a radial
pulse."
"Hang normal saline wide open. And do a cutdown, please,
Jonathan. Olivia said. This woman needed blood fast.
"Olivia, this isn't the goddamned District of Columbia.
She needs a trauma unit."
"Start a bicarb bolus," she said to Lynn. "And
epinephrine. And get that blood hung." Then she turned to
Jonathan. "Look. We can ship her up to Emerson and you and
I both know she'll die on the way. Working on her here
might not be ideal, but it's the only chance she has." She
turned back to the table and did the cut-down herself,
slipping the scalpel into the blue vein in the woman's
groin. She picked up the large bore needle.
"I can do it." Kathy took the needle from her and fit it
into the vein. Her hands no longer trembled and Olivia
admired her for getting her fear under control so quickly.
Jonathan glowered at her. "I won't be a part of this. I'm
calling the helicopter." He turned on his heel and walked
out of the room.
Olivia stared after him, dumbfounded. "I don't believe
it." She turned to one of the paramedics. "Call Dr.
Shelley," she said. "Tell him to get over here stat." She
began swabbing Betadine on the woman's chest and side.
Then she slipped her hands into the sterile gloves Lynn
held out to her.
"Maybe we should send her up," Lynn said quietly.
Perspiration glowed on her forehead.
"We're going to do our best for her, Lynn." Olivia picked
up a second scalpel from the tray and noticed the tremor
in her own hand. She was suddenly aware of being the only
physician in the room. Steady, come on, steady. She set
the scalpel between the woman's ribs and felt all her
concentration flow into the task ahead of her. She bore
down. No blood at all. She cut deeper, through the layers
of muscle, until she reached the heart cavity. Blood
suddenly gushed from the wound she'd created. It poured
down the front of her scrubs and onto the floor, and the
paramedic standing nearest her let out a moan.
"No BP," Lynn said. "And no pulse."
Olivia looked up at the flat green line on the monitor
behind the patient's head. She felt a film of sweat break
out across her own forehead. They were losing her. She had
to widen the incision. She looked at the tray of
instruments. "No rib spreader?"
Kathy shook her head.
Of course they had no rib spreader. Olivia set the scalpel
again and forced it through the woman's fifth rib. Once
the wound was wide enough, she slipped her hand inside.
She cautiously curved her fingers around the woman's
heart, then slid her thumb over the surface, hunting for
the bullet hole. She found it quickly — a little dimple in
the heart's smooth surface — and held her thumb over it to
block the flow of blood. Then she found the exit wound in
the back of the heart. She covered it with her middle
finger and felt the heart contract in her palm. She looked
at the monitor as a cheer went up in the room.
"We've got a pulse!" Kathy said.
Olivia smiled and let out her breath. There was little
they could do now except wait for Mike Shelley, the
director of the ER, to get over here. She wasn't sure how
long she could hold her position. It was painfully
awkward. She was nearly crouching, her spine twisted to
keep her hand in the right position on the heart. If she
moved her fingers, the woman would die. It was that
simple. The muscles in her thighs began to quiver, and her
shoulder ached.
She could hear the helicopter making its approach, the
familiar thud as it landed on the roof. She hoped they
would need it, hoped they could repair the damage to this
woman's heart and stabilize her well enough to make the
trip.
For the first time she looked at the woman's face. Her
skin was white and lightly freckled. She wore no makeup.
Her hair was cherry-wood red, long and full. It fell over
the edge of the table in a mass of corkscrew curls. She
looked like an advertisement for Ivory soap.
"Who shot her?" She raised her eyes to the younger of the
two paramedics, trying to get her mind off her own
discomfort.
The paramedic's face was as white as the patient's, his
brown eyes wide. "She was a volunteer at the Battered
Women's Shelter in Manteo," he said. "Some guy came in,
threatening his wife and kid, and this lady got in the
way."
The Battered Women's Shelter Olivia felt a spasm of pain
in her own chest. She had to force herself to ask the next
question. "Does anyone know her name?"
"Annie somebody," said the paramedic. "O'Brien. O'Some
thing."
"O'Neill Olivia whispered, so quietly none of them heard
her. She let her eyes run over the body in front of her,
over the creamy white, freckled breasts, the softly
sloping waistline. She closed her eyes. Her shoulder
burned; the tips of her fingers were numb. She was no
longer certain they were in exactly the right place. She
lifted her eyes back to the monitor. She would be able to
tell by any change in the heartbeat if her fingers were
slipping.
Had it only been a month since Paul had written that
article for Seascape Magazine? She remembered the pictures
of the stained glass in Annie Chase O'Neill's studio. The
women in silk, the sleek blue heron, the sunset on the
sound. Paul had changed after that story. Everything had
changed.
Mike Shelley arrived and she saw in his dark eyes his
shock at the scene. But he scrubbed quickly and was at her
side in seconds. "Where's Jonathan?" he asked.
"He thought she should go up and I thought she should
stay. So he left to call the helicopter and he hasn't come
back."
Mike threaded the curved needle with his gloved
hands. "Maybe she should have gone up." He spoke very
quietly, very softly, his lips close to her ear. "This way
her blood's on your hands."
Olivia's eyes stung. Had she made the wrong decision? No,
this woman would never have survived the trip. Never.
Mike had to work around her fingers. If she moved just a
fraction of an inch, the blood poured from the bullet
holes. The pain in Olivia's shoulder became a steady fire
and the shaking in her legs spread to the rest of her
body. Still she held her position while Mike slipped a
tiny piece of felt beneath her thumb and stitched it into
place. But the exit hole was not so easy to close. It was
large and nearly impossible to reach without damaging the
heart in the process.
She watched the lines deepen in Mike's forehead as he
struggled with the needle.
"Please, Mike," she whispered.
He finally shook his head. The felt refused to hold, and
the blood seeped, then poured from the back of the heart.
Olivia felt the heat of it on her fingers as the green
line of the monitor shivered and flattened, and the room
grew hushed with failure.
For a moment on one moved. No one spoke. Olivia could hear
Mike's breathing, rapid and deep, keeping time with her
own. She straightened up slowly, gritting her teeth
against the pain in her back, and looked at Kathy. "Is any
of her family here?"
Kathy nodded. "Yes, and we called Kevin in. He's with them
in the little waiting room."
"I'll tell them," Mike said.
Olivia shook her head. "I should do it. I was with her
from the start." She turned and started walking toward the
door.
"Whoa." Mike caught her arm. "Better change first."
She looked down at her blood-soaked scrubs and felt a
ripple of doubt. She was not thinking clearly.
She changed in the lounge and then walked to the small,
private waiting room. Through the high window in the
hallway she caught a glimpse of snowflakes dancing in the
darkness. She wished she could step outside for a second.
Her muscles still burned. And she hated what lay ahead of
her. She hoped Kevin Rickert, the social worker, had
prepared them for what she had to say.
Kevin looked relieved to see her. "This is Dr, Simon," he
said.
There were three of them — a girl about thirteen who
looked strikingly like the woman she had just left on the
table, a boy a few years older. And a man. Annie's
husband, Alec O'Neill. He was dark-haired, tall and thin,
with an athletic tightness to his body. He wore jeans and
a blue sweater, and he held his hand toward her,
tentatively, his pale blue eyes asking her what his future
held.
She shook his hand quickly. "Mr. O'Neill." She would make
the words come out very slowly. "I'm so sorry. The bullet
went straight through her heart. The damage was too
extensive."
There was still hope in his eyes. It was always that way.
Until you said it clearly, until you stopped mincing
words, that hope would be there. The son understood,
though. He looked like a younger version of his father —
the same black hair, striking pale blue eyes beneath dark
brows. He turned to face the wall, his shoulders heaving,
although he made no sound.
"Do you understand what Dr. Simon is saying?" Kevin asked.
The man stared at her. "Are you saying Annie's dead?"
Olivia nodded. "I'm sorry. We worked on her for over an
hour but there was . . ."
"No!" The girl threw herself at Olivia, knocking her into
the wooden arm of one of the chairs. She flailed at her
with closed fists, but Kevin wrapped his arms around her
from behind before she could cause any real harm. "She
can't be dead!" the girl screamed. "There wasn't any
blood."
Alec O'Neill extracted the girl from Kevin's grip and
pulled her into a hug. "Shh, Lacey."
Olivia regained her balance and set a hand on the girl's
back. How did she know about the blood? "She was bleeding
inside, honey," Olivia said.
The girl pushed Olivia's arm away. "Don't call me honey."
Alec O'Neill pulled Lacey closer to him and she began to
weep against his chest. Olivia looked at Kevin. She felt
helpless.
"I'll stay with them," Kevin said.
Olivia walked to the door but turned back to face the
family once more. "If you have any questions, please call
me."
Alec O'Neill looked across the room at her and Olivia
stood fast, forcing herself to face the hurt in his eyes.
She'd taken something from him. She needed to give him
something back.
"She was very beautiful," she said.
Jonathan and the helicopter pilot were standing in the
hallway, and she had to pass them to get to her office.
"Nice job," Jonathan said, his tone mocking.
She ignored him and walked into her office, where she
cranked open her windows to let in the cold air. The snow
was still failing, so silently that when she held her
breath she could hear the thunder of the ocean two blocks
away.
After a while, Kevin poked his head in her door. "You
okay, Olivia?"
She turned away from the window, sat down behind her
desk. "Yes. How's her family?"
Kevin stepped into the room. "Dad and the son went in to
see her," he said as he sat down across the desk from
her. "Daughter didn't want to. I think they'll be okay.
Pretty solid family. Mom was the hub, though, you know, so
it's hard to say." He shook his head. "Life sucks
sometimes, doesn't it?"
"Yes."
"Looks like this one was pretty rough on you."
She felt a tear hit her cheek and Kevin plucked a tissue
from the box on her desk and handed it to her.
"Cramer's an asshole," he said.
"I'm all right." She sat up straight, blew her nose. "So,
do you ever have to comfort Jonathan or Mike? Hand them
tissues?"
Kevin smiled. "You think women have exclusive rights on
feeling like shit?"
She thought of Alec O'Neill's eyes when she'd left the
waiting room. Those eyes were going to haunt her for a
long time. "No, I guess not," she said. "Thanks for
stopping in, Kevin."
It was after seven. Her shift was long over. She could
leave now, any time she wanted, She would drive to her
house on the sound where she would have to tell Paul what
had happened tonight, and for the second time that night
she would watch a man crumble. What was it about Annie
O'Neill?
Olivia looked down at her hand where it rested in her lap.
She turned it palm side up and thought she could still
feel it — the life, the warmth of Annie's heart.