“It’s okay,” Sara whispered. She stroked the woman’s dirty brown hair back behind her ear, remembering that she had done the same thing for Sibyl just two days ago. The vomiting stopped abruptly, and Sara gently rolled her back over, keeping her head steady.
Hare’s tone was urgent. “She’s not breathing.”
Sara cleared the woman’s mouth with her finger, surprised to feel some resistance. After a few seconds of digging, she pulled out a folded driver’s license, which she handed to a surprised Lena Adams.
“Breathing’s back,” Hare said, relief flooding his voice.
Sara rubbed her fingers clean on her skirt, wishing she’d had on a pair of gloves before she had stuck her fingers into the woman’s mouth.
Ellen jogged to the car, her jaw set as she angled a long stretcher in front of her. Without words, she stepped to the woman’s feet, waiting for Sara’s signal.
Sara counted to three, then they both moved the woman onto the bed. Sara felt a sick taste in her mouth as they did this, and for a few seconds she saw herself on the bed instead of the woman. Sara’s mouth went dry and she felt a numbness overcome her.
“Ready,” Hare said, strapping the woman to the bed.
Sara trotted beside the gurney, holding on to the young woman’s hand. The time it took them to get back into the hospital was interminable. The bed seemed to be rolling through glue as they entered the first trauma room. The woman made small murmurs of pain with each jolt of the bed. Briefly, Sara latched on to the woman’s fear.
Twelve years had passed since Sara had practiced emergency medicine and she needed to concentrate on the tasks at hand. In her head, Sara went over what she’d learned her first day in the ER. As if to prompt Sara, the woman started wheezing, then gasping for air. The first priority was to establish an airway.
“Jesus,” Sara hissed as she opened the woman’s mouth. Under the bright lights of the exam room, Sara could see that her top front teeth had been knocked out, obviously within the last few days. Again, Sara felt herself freezing up. She tried to shake this off. Sara had to think of this woman as a patient or they would both be in trouble.
In seconds Sara had intubated the woman, careful with the tape so as not to do further damage to the skin around the mouth. Sara fought the urge to cringe as the ventilator kicked in. The sound almost sickened her.
“She’s got good sounds,” Hare reported, handing Sara a stethoscope.
“Sara?” Ellen said. “I can’t get a peripheral.”
“She’s dehydrated,” Sara reported as she tried to find a vein on the woman’s other arm. “We should drop a central anyway.” Sara held her hand out for the needle, but one was not immediately placed in her hand.
“I’ll get it from two,” Ellen said, then left the room.
Sara turned back to the young woman on the bed. There did not seem to be any bruises or cuts on her body other than the marks on her hands and feet. Her skin was warm to the touch, which could point to any number of things. Sara did not want to jump to conclusions, but already the similarities between Sibyl Adams and the woman in front of her were going through her mind. They were both petite women. They both had dark brown hair.
Sara checked the woman’s pupils. “Dilated,” she said, because the last time she’d done something like this, the rule had been to call out your findings. She exhaled slowly, noticing for the first time that Hare and Lena were in the room.
“What’s her name?” Sara asked.
“Julia Matthews,” Lena provided. “We were looking for her at the school. She’s been missing for a couple of days.”
Hare glanced at the monitor. “Pulse ox is falling.”
Sara checked the ventilator. “Fi02 is thirty percent. Bump it up a little.”
“What’s that smell?” Lena interrupted.
Sara sniffed the woman’s body. “Clorox?” she asked.
Lena caught another whiff. “Bleach,” she confirmed.
Hare nodded as well.
Sara examined the woman’s skin carefully. There were lines of superficial scrapes all along the body. Sara noticed for the first time that the woman’s pubic hair had been shaved off. From the lack of growth, Sara guessed she had been shaved in the last day or so.
Sara said, “She’s been scrubbed clean.”
She smelled the woman’s mouth but did not pick up the strong scent that usually comes from ingesting bleach. Sara had seen some rawness in the back of the throat when she’d tubed the woman, but nothing out of the ordinary. Obviously the woman had been given a drug similar to if not actually belladonna. Her skin was so hot to the touch that Sara could feel it through her gloves.
Ellen entered the room. Sara watched the nurse as she opened the central line kit on one of the trays. Ellen’s hands didn’t seem as steady as they usually did. This scared Sara more than anything else.
Sara held her breath as she jabbed the three-inch needle into the woman’s jugular. The needle, called an introducer, would act as a funnel for three separate IV ports. When they found out what kind of drug the woman had been given, Sara would use one of the extra ports to help counteract the effects.
Ellen stood back from the patient, waiting for Sara’s orders.
Sara rattled off the tests as she flushed the ports with heparin solution to keep them from clotting. “Blood gases, tox screen, LFT, CBC, chem twenty-seven. Go ahead and pull for a coag panel while you’re at it.” Sara paused. “Dip her urine stat. I want to know what’s going on before I do anything else. Something’s keeping her knocked out. I think I know what it is, but I need to be sure before we start treatment.”
“All right,” Ellen answered.
Sara checked for positive blood return, then flushed the lines again. “Normal saline, wide open.”
Ellen did as she was told, adjusting the IV.
“Do you have a portable X ray? I’ll need to make sure I did this right,” Sara said, indicating the internal jugular line. “Plus I need a chest, a flat of the abdomen, and a look at her shoulder.”
Ellen said, “I’ll get it from down the hall after I draw the blood work.”
“Also, check for GHB, roofies.” Sara spoke as she secured the dressing around the needle. “We’ll need to do a rape kit.”
“Rape?” Lena questioned, stepping forward.
“Yes,” Sara answered, her tone sharp. “Why else would someone do this to her?”
Lena’s mouth worked, but no answer came. She had obviously kept this case separate from her sister’s up until that point. Lena’s eyes locked on to the young woman, and she stood at the foot of the bed, her body ramrod straight. Sara was reminded of the night Lena had come to the morgue to see Sibyl Adams. The young detective’s mouth was set in that same angry line.
“She seems stable,” Ellen offered, more to herself than anyone else.
Sara watched as the nurse used a small syringe to draw blood from the radial artery. Sara rubbed her own wrist, knowing how painful the procedure could be. She leaned against the bed, her hands on Julia Matthews’s arm, trying to somehow convey that she was safe now.
Hare brought her back with a gentle “Sara?”
“Hm?” Sara was startled. They were all looking at her. She turned to Lena. “Can you help Ellen with the portable?” she asked, trying to use a firm voice.
“Yeah,” Lena returned, giving Sara an odd look.
Ellen filled the last syringe. “It’s down the hall,” she told Lena.
Sara heard them leave, but she kept her eyes on Julia Matthews. Sara’s vision tunneled, and for the second time she felt herself on the gurney, saw a doctor leaning over her, taking her pulse, checking her vitals.
“Sara?” Hare was looking at the woman’s hands, and Sara was reminded of the marks she had first seen in the parking lot.
Both palms were punctured through the center. Sara glanced down at the woman’s feet, noting that they, too, had been punctured in the same way. She bent to examine the wounds, which were clotting rapidl
y. Specks of rust added color to the dried black blood.
“The palm has been pierced through,” Sara offered. She looked under the woman’s fingernails, recognizing thin slivers of wood pressed under the nails. “Wood,” she reported, wondering why someone would take the time to scrub the victim down with bleach in order to remove physical traces, yet leave slivers of wood under the nails. It did not make sense. And then to leave her arranged on the car in such a way.
Sara worked all of this out in her head, and her stomach responded to the obvious conclusion with a slight pitch. She closed her eyes, picturing the woman as she had been when Sara first found her: legs crossed at the ankles, arms at ninety-degree angles from the body.
The woman had been crucified.
“Those are puncture wounds, right?” Hare said.
Sara nodded, not taking her eyes off the woman. Her body was well nourished and her skin had been taken care of. There were no needle marks to indicate prolonged drug use. Sara stopped in her tracks, realizing she’d assessed the woman as if she were at the morgue rather than the hospital. As if sensing this, the heart monitor went into failure, the shrill scream of the machine putting Sara on alert.
“No,” Sara hissed as she leaned over the woman, starting compressions. “Hare, bag her.”
He fumbled around in the drawers for the bag. Within seconds, he was squeezing air into the woman’s lungs. “She’s in V-tach,” he warned.
“Slow,” Sara said, wincing as she felt one of the patient’s ribs crack under her hands. She kept her eyes on Hare, willing him to cooperate. “One, two, squeeze. Quick and hard. Keep it calm.”
“Okay, okay,” Hare mumbled, concentrating on squeezing the bag.
Despite the great press given CPR, it was merely a stopgap measure. CPR was the act of physically forcing the heart to circulate blood into the brain, and very rarely could this be done manually as efficiently as a healthy heart performing the task on its own. If Sara stopped, so would the heart. It was a time-buying procedure until something else could be done.
Lena, obviously alerted by the shrieking monitor, ran back into the room. “What happened?”
“She crashed,” Sara said, feeling a slight sense of relief as she spotted Ellen in the hallway. “Amp of Epi,” she ordered.
Sara watched impatiently as Ellen popped open a box of Epi and put the syringe together.
“Jeesh.” Lena cringed as Sara administered the drug straight into the woman’s heart.
Hare’s voice rose a few octaves. “She’s in V-fib.”
With one hand Ellen took the paddles off the cart behind her, charging the defibrillator with the other.
“Two hundred,” Sara ordered. The woman’s body jumped into the air as Sara electrocuted her. Sara watched the monitor, frowning when there was no corresponding reaction. Sara shocked her two more times with the same response. “Lidocaine,” she ordered just as Ellen popped another box.
Sara administered the drug, keeping an eye on the monitor.
“Flat line,” Hare reported.
“Again.” Sara reached for the paddles. “Three hundred,” she ordered.
Again, she shocked the woman. Again, there was no response. Sara felt a cold sweat come over her. “Epi.”
The sound of the box popping open was like a needle in Sara’s ear. She took the syringe, pushing the Adrenalin directly into the woman’s heart one more time. They all waited.
“Flat line,” Hare reported.
“Let’s go to three-sixty.”
For the fifth time, a charge went through the woman’s body with no response.
“Goddamnit, goddamnit,” Sara muttered, resuming compressions. “Time?” she called.
Hare glanced at the clock. “Twelve minutes.”
It had seemed like two seconds to Sara.
Lena must have sensed from Hare’s tone of voice where he was going with this. She whispered under her breath, “Don’t let her die. Please, don’t let her die.”
“She’s in prolonged asystole, Sara,” Hare said. He was telling her that it was too late. It was time to stop, time to let go.
Sara narrowed her eyes at him. She turned to Ellen. “I’m going to crack her chest.”
Hare shook his head, saying, “Sara, we don’t have the capabilities here.”
Sara ignored him. She felt down the woman’s ribs, cringing as she made contact with the one she had broken. When Sara’s fingers reached the bottom of the diaphragm, she took a scalpel and sliced a six-inch opening into the upper abdomen. She slipped her hand into the incision, reaching under the rib cage and into the woman’s chest.
She kept her eyes closed, blocking out the hospital as she massaged the woman’s heart. The monitor showed false hope as Sara squeezed, manually circulating the woman’s blood. A tingling came to her fingers, and in her ears she could hear a slight piercing tone. Nothing else mattered as she waited for the heart to respond. It was like squeezing a small balloon filled with warm water. Only this balloon was life.
Sara stopped. She counted to five seconds, eight, then up to twelve, before being rewarded with spontaneous beeps from the heart monitor.
Hare asked, “Is that her or you?”
“Her,” Sara offered, letting her hand slip out. “Start a lidocaine drip.”
“Jesus Christ,” Lena muttered, hand to her own chest. “I can’t believe you just did that.”
Sara snapped off her gloves, not answering.
The room was quiet but for the beeps of the heart monitor and the in and out of the ventilator.
“So,” Sara said. “We’ll do a darkfield for syphilis and a gram stain for gonorrhea.” Sara felt her face flush over this. “I’m sure a condom was used, but make a note to follow up in a few days for pregnancy.” Sara was conscious of a waver in her voice that she hoped Ellen and Lena did not pick up. Hare was another matter. She could hear what he was thinking without even looking at him.
He seemed to sense her nervousness and tried to make light of it. “Good God, Sara. That’s the sloppiest incision I’ve ever seen.”
Sara licked her lips, willing her own heart to calm. “I was trying not to upstage you.”
“Prima donna,” Hare offered, wiping perspiration from his forehead with a pad of surgical gauze. “Jesus Christ.” He laughed uncomfortably.
“We don’t see much of this around here,” Ellen said as she packed surgical towels into the incision to control the bleeding until it was closed. “I can call Larry Headley over in Augusta. He lives about fifteen minutes from here.”
“I would appreciate that,” Sara said, taking another pair of gloves from the box on the wall.
“You okay?” Hare asked, his tone casual. His eyes showed his concern.
“Fine,” Sara answered, checking the IV. She told Lena, “I guess you can find Frank?”
Lena had the decency to look embarrassed. “I’ll go see.” She left the room, her head down.
Sara waited until she was gone, then asked Hare, “Can you take a look at her hands?”
Hare was silent as he examined the woman’s palms, feeling the bone structure. After a few minutes, he said, “This is interesting.”
Sara asked, “What’s that?”
“Missed all the bones,” Hare answered, rotating the wrist. When he got to the shoulder, he stopped. “Dislocated,” he said.
Sara crossed her arms, suddenly cold. “From trying to get away?”
Hare frowned. “Do you realize how much force it would take to dislocate your shoulder blade?” He shook his head, unable to accept it. “You’d pass out from the pain before you’d—”
“Do you realize how terrifying it is to be raped?” Sara’s gaze bored right into him.
Pain registered in his expression. “I’m sorry, honey. Are you okay?”
Tears stung the back of her eyes, and Sara had to fight to keep her voice even. “Check her hips, please. I want you to do a full report.”
He did as he was told, giving Sara a curt nod after the
examination. “I’m thinking there’s some ligature damage in the hip, here. I need to do this when she’s awake; it’s fairly subjective.”
Sara asked, “Can you tell anything else?”
“All the bones in her hands and feet were missed. Her feet were speared between the second and third cuneiforms and the navicular. That’s very precise. Whoever did it knew what he was doing.” He paused, looking down at the floor to regain his composure. “I don’t see why someone would do this.”
“Look at this,” Sara said, pointing to the skin around the woman’s ankles. They both had angry black bruises around their circumference. “Obviously there was a secondary restraint to hold the feet down.” Sara picked up the woman’s hand, noticing a fresh scar at the wrist. The other had the same mark. Julia Matthews had attempted suicide at some point during the last month. The scar was a white line slashing vertically across her small wrist. A dark bruise put the old wound in stark relief.
Sara did not bring this to Hare’s attention. Instead, she offered, “It looks to me like a band was used, probably leather.”
“I’m not following.”
“The piercing was symbolic.”
“Of?”
“Crucifixion, I would imagine.” Sara put the woman’s hand back by her side.
Sara rubbed her arms, fighting the chill in the room. She walked over, opening drawers, looking for a sheet to cover the young woman. “If I had to guess, I would say that the hands and feet were nailed back from the body.”
“Crucifixion?” Hare dismissed this. “That’s not how Jesus was crucified. The feet would be together.”
Sara snapped, “Nobody wanted to rape Jesus, Hare. Of course her legs were spread apart.”
Hare’s Adam’s apple bobbed as he swallowed this. “Is this what you do at the morgue?”
She shrugged, looking for a sheet.
“Christ, you’ve got more balls than I do,” Hare said, breathing heavily.
Sara tucked the sheet around the young woman, trying to comfort her. “I don’t know about that,” she said.
Hare asked, “What about her mouth?”
“Her front teeth were knocked out, I imagine to facilitate fellatio.”