“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’Something.”

“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 no 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.”