The flight was a go. By the time she had suited up, climbed into the cockpit, and run through the rest of her preflight check, Linda and Juan, the paramedic, were waiting, helmets in hand, ready to board.

“Where’s the doctor?” Jett yelled from the cockpit.

“Should be here any second,” Linda called back.

Jett disliked civilian physicians in her aircraft. They weren’t used to flying and weren’t used to taking orders. With one aboard, she had one more thing to worry about, but there was nothing she could do about it. The civilian world operated differently than the Army, where rank trumped everything, including education or perceived skills.

Despite the fact that her medcrew was trained to handle anything out in the field, if the first responders wanted a physician, then a physician they would get.

At that moment, the double glass doors enclosing the elevator lobby in the far corner of the rooftop opened wide and a woman in pale blue scrubs sprinted out toward them. An assortment of beepers bounced on the waistband of her scrub pants, and a stethoscope danced around her neck. Jett gave her a cursory glance. She appeared young, probably a resident, her body muscular and fit-looking. Her collar length brunette hair was thick and casually styled. In the harsh lights of the helo deck, her blue eyes stood out in startling contrast to her olive complexion.

“Make sure she gets squared away,” Jett called to Linda before starting her engines. Out of the corner of her eye, she saw Linda grab the doctor by the arm, and all three ducked their heads, ran under the spinning rotors, and climbed aboard. After giving them a second to strap in, Jett took the helicopter up from the roof of the main hospital building and headed northwest toward the turnpike. She checked her watch. Four minutes and twenty-five seconds.

She was flying. Life was good, for these few minutes, anyhow.

“What’s going on?” Tristan shouted to the woman who had introduced herself as Linda as she pulled the safety harness across her chest. She didn’t know either of the flight crew, and all she could see of the pilot was a strong profile, dark eyes, and thick sandy hair sticking out from under the back of her helmet. Tristan had a brief instant to register that the pilot was female and good-looking before her mind honed in on the question of what faced her. All she’d gotten from the paramedic who phoned her was that Healthstar needed a doctor, and Tristan’s name was on the top of the roster tonight. She was double boarded in anesthesia and critical care, like a lot of anesthesia docs, so when her new chief had asked her if she’d take trauma call, she’d said sure. She’d never been up in a helicopter before, and this wasn’t exactly what she’d had in mind for her first time. A romantic ride with a beautiful woman around Manhattan, a view of the Statue of Liberty in the background, was more what she had pictured. Even though a glance out the window told her that the scenery from here would be pretty spectacular, knowing what waited for her—or rather, not knowing— definitely killed the mood. The two people beside her were better equipped to deal with most emergencies in the field than she was. Her expertise was hospital-based and most of what she did was in a room filled with high-tech equipment, a multitude of drugs, and sophisticated monitoring devices. “You have a report on the patient?”

“Details are sketchy,” Linda replied, handing Tristan a radio headset with a microphone. “It’s the governor’s daughter-in-law. MVA. Reports are she’s in bad shape.”

“Shit.” Tristan could see it now. Not only would they have to deal with a critically injured patient, they’d probably have news people crawling all over them, documenting everything they did or didn’t do. It was a PR nightmare, and as the physician on scene, she was going to get all the attention.

“No kidding,” Linda said.

“I’ll take a quick look at her airway,” Tristan said, “then you two concentrate on securing the victim, just like you would if I wasn’t there. Anything you need me to do, tell me. I guess you know not to talk to anyone.”

Linda grinned. “Oh yeah, we know all about that. HIPAA HIPAA hooray.”

A lot sooner than she expected, Tristan realized they were landing at the edge of a field adjoining the turnpike. The accident scene below pulsed with a life of its own as the lights of a dozen emergency vehicles beat against the night sky. Two other helicopters were setting down simultaneously, hovering like menacing behemoths over the ring of patrol cars, ambulances, and fire engines whose headlights illuminated a jackknifed tractor-trailer and three mangled automobiles. Two forlorn, white-tarp-covered forms lay alone on the oil-stained highway while rescue workers swarmed around the wreckage, tending to the still-living.

The instant the helicopter touched down, Tristan jumped out behind Linda and Juan. Following Linda’s directions, she helped unload a stretcher and rapidly piled emergency equipment on top. Then she set off running with them toward the scene.

“We’re from PMC,” Linda called to a man with a lot of gold braid on his uniform cap who Tristan figured was the incident commander. He held two radios and was waving emergency crews in various directions.

“Over there,” he directed.

Tristan looked where he pointed. A cluster of emergency personnel knelt on the highway inside a loose ring of state police. Two news vans were angled on the shoulder of the road and a handful of reporters with television cameras strained against a temporary barricade of yellow crime scene tape, trying to get footage. The patient, assuming she was in there somewhere, was not visible.

“Jesus,” Tristan muttered under her breath.

Juan cleared the way by announcing who they were, and the crowd parted enough to let them through. When she finally cleared the protective ring of cops and the assorted curious, Tristan saw a woman in her early thirties, unconscious, bleeding profusely from obvious facial injuries. Judging from the victim’s position, Tristan surmised she’d been ejected from a vehicle—probably the overturned Lexus SUV covered with flame retardant foam that was now resting on the median.

Her right leg was angulated, a portion of the femur protruding through a long rent in her once-white slacks. With trauma to both her head and lower extremities—bracket injuries—there was a good chance she had internal injuries as well. She already had IVs running in both arms.

Tristan dropped to her knees by the patient’s head and placed her stethoscope quickly on both sides of the patient’s chest, listening for breath sounds. She heard no air movement on the right. “Pneumothorax on the right.”

While Juan positioned the backboard next to the victim, Linda opened the emergency equipment box and pulled out a thin trocar with an attached flexible polyethylene tube connected to a syringe. She pushed aside the remnants of the patient’s bloodstained blouse, quickly swabbed a spot below her breast with antiseptic, and pushed the three inch needle between her ribs. Then she slid the tubing in after it and used the syringe to evacuate the air from the patient’s chest. As Tristan listened, breath sounds returned. It was a temporary measure, but it would do for now.

“Better,” Tristan said.

Despite the improvement in airflow, the patient’s breathing was labored. Fractured ribs. Tristan gently palpated her jaw. The mandible shifted beneath her fingers with a grating sensation. Fractured as well, and probably her mid-face too, if the amount of blood streaming from her nose was any indication. With this much hemorrhage and mobile facial fractures, her airway was very unstable.

“She needs to be intubated.”

When Tristan glanced up, Juan already had a laryngoscope out and handed it to her. Using the portable suction, he cleared some of the blood out of the patient’s mouth while Tristan inserted the scope’s flat metal blade with a light at the end into the back of her throat. Moving the tongue aside and carefully lifting up on the jaw so as not to move the victim’s head, Tristan squinted into the oral cavity, hoping to find some landmarks. Unfortunately, with the continued bleeding and massive swelling, she couldn’t see a thing. Still searching for anatomical landmarks, she held out her free hand for the endotracheal tube and made a blind pass in the direction of the trachea—or at least where she hoped the trachea was. She really needed to get this tube in, because the last thing she wanted to do was an emergency trach in the field. Too much risk to the patient, especially one with an unstable neck. Tristan eased the tube in a little more. God, she hated blind intubations. Please, baby, come on.

Juan pressed his fingers to the patient’s throat, and as Tristan continued to push, he nodded and said, “Feels like it’s going through the cords.”

Tristan persisted until only a few inches of the tube protruded from the patient’s mouth. Then she took the ambu bag that Linda had connected to the oxygen tank and carefully hooked it to the end of the endotracheal tube. She squeezed the inflatable bag while Linda listened to the patient’s chest.

“You got it,” Linda announced with satisfaction. “Good breath sounds on both sides.”

“All right then,” Tristan said. “Let’s get her on the backboard and go.”

Tristan stabilized the head, Juan placed a cervical collar, and then on Linda’s count, they rolled the patient, slid the backboard underneath her, and strapped her down. While Linda secured the IVs, O2, and other tubes, Juan splinted her leg. Within minutes, they were ready to go. As they worked, Tristan could hear shouted questions from the reporters.

“Is that Marsha Eisman?”

“How badly is she injured?”

“Does the governor know?”