“Is she diabetic?”

“No—not that she knows of. I sent off bloods and don’t have them back yet. But her temp is a hundred and three and the wound looks nasty. Swollen and draining.”

On the surface it sounded like a virulent cellulitis, but Cindy wouldn’t have called her for a straightforward infection. She’d have called one of the medical doctors for antibiotics and possible admission.

“What else?” Glenn asked.

Cindy shook her head, her eyes troubled. “She just looks really sick, Glenn—a lot sicker than something like a fairly superficial trauma should account for. And there’s a lot of swelling. I was afraid something might’ve gotten in there that she didn’t realize, some kind of foreign body, so I sent her to X-ray.”

“You know,” Glenn said, impressed as always by Cindy’s clinical sense, “there’s an opening in the rotation for first-year PAs. You might consider—”

“No way. I’m done with school, even if I do have an in with the new program director.”

The title still felt like a too-tight shoe, and Glenn shrugged aside thoughts of her new job. “Where are the X-rays?”

“I put them on a box outside her room.”

“Okay, I’ll check her out. Let me know as soon as you get her labs back.”

“I’ll call now.” Just as Cindy reached for the phone, the red triage phone rang. Cindy gave a little shrug and picked that one up instead. “ACH—go ahead.”

Glenn walked down to cubicle seven and announced herself as she pulled the curtain aside. “Ms. Purcell? I’m Glenn Archer, one of the surgical PAs.”

Naomi Purcell sat propped up on several pillows, her eyes fever bright in a pale white face. Lank strands of medium brown hair framed her face. Sweat beaded on her forehead, and her chest beneath the shapeless cotton hospital gown fluttered with quick, shallow breaths. A tall, husky man in a faded T-shirt hanging over the top of baggy blue jeans stood to the left side of the bed, his hand on her shoulder and terror in his eyes.

“She seems to be getting sicker really fast, Doc,” he said in a low, tight voice.

“I’m fine, Todd.” Naomi Purcell’s voice was wispy and faint but she mustered a smile. “My leg feels like a nest of fire ants are having a picnic on it, though.”

“Let me take a look.” Glenn snapped on gloves and drew back the sheet, expecting to see the angry laceration Cindy had noted on the chart along with the bright red sheen of a superficial infection surrounding it. All the expected signs of infection were there, but nothing about Naomi Purcell’s leg was typical. An irregular inch-long gash just above her left ankle gaped open, and a thin milky fluid oozed from its edges, slowly trickling down onto the sheet. Her foot was swollen to twice its size, the skin thin and tight as if trying to prevent the flesh and fluid beneath from bursting out and close to losing the battle. She checked for the dorsal pulse and couldn’t find it. “Can you feel me touch you?”

“Yes, a little. My toes are numb, though.”

“Do they feel cold?”

“No. More like they’re just not there.”

The inflammation extended up her calf following the path of lymphatic drainage, spidery fingers spreading toxins and whatever bacteria had invaded the deeper tissues. Glenn felt for the artery behind Naomi’s knee and found the rapid beat that signaled Naomi’s system was working hard to combat the infection. “This might hurt a little bit.”

“Don’t worry about me,” Naomi said, as if Glenn had anything else to worry about.

Right now, Naomi Purcell was the only thing that mattered in her life. She gently probed at a distance from the laceration, and a faint crackle, like air popping in the plastic bubble things they wrapped around packages that come in the mail, crinkled beneath her fingertips. Her belly tightened and she straightened up. “I want to check your X-rays. I’ll be right back.”

“She should get some antibiotics, right, Doc?” Naomi’s husband Todd said.

“Yes, and we’ll get on that in just a minute.”

His eyes followed her out of the room. Eyes that said, Don’t leave us. Help us. Eyes she’d seen hundreds of times before. Three X-rays hung on the light box next to the curtained cubicle. The bones of the lower leg stood out like bleached driftwood, balloon-shaped shadows marking the surrounding muscles and fat. And there in the depths of the tissue, clear streaks like icing in a layer cake extended from the edges of the laceration. Air where there shouldn’t be any. She found Cindy drinking a cup of coffee and making notes in a stack of charts in the tiny staff lounge. “We need to start her on antibiotics—I’ll get cultures and call Flann.”

“It’s bad, isn’t it?”

“It’s necrotizing fasciitis, and she needs to go to the OR, right now. I should call Williams, but Flann’s upstairs—”

“God, don’t call Williams. If you do, she’ll be sitting down here until after he’s had his morning coffee.”

“You did good calling me.”

“I knew you’d come. You always do.”

Of course she did, what else would she be doing. She scribbled an order for an antibiotic cocktail and called up to the OR. Dave Pearson, an OR tech, answered. “Hey, Dave, it’s Glenn. Can you patch me into Flann’s room?”

“Sure, hold on. You got something?”

“Yeah—do you have another team?”

“We can put something together if it can’t wait until Flann is done.”

“Let’s see what she says.”

A second later the line buzzed and a woman answered. “OR seven.”

“Fay, it’s Glenn Archer. Can Flann talk?”

“Hold on a second…Flann, it’s Glenn. Can you talk?”

“Glenn?” Flann said. “What are you doing? I thought you’d moved on to greener pastures.”

“Not until seven a.m. I’m down in the ER. Cindy called me. There’s a thirty-five-year-old woman here with necrotizing fasciitis of her left lower extremity. Right now it’s in the midcalf, but the wound is less than twenty-four hours old, and she looks toxic. She needs to come up.”

“Damn it,” Flann muttered. “We’ve got another half an hour before we can test the shunt. Pete can close after that. If they can set up another room, you can get started.”

“Dave says they can. I’ll get her upstairs.”

“You started her on bug killers?”

“As we speak.”

“Let me know as soon as she’s asleep, and I’ll put my head in if I’m not free yet.”

“Okay, no problem.”

Husband and wife fixed Glenn with anxious gazes as soon as she stepped through the curtain. “You’ve got an infection in your leg, you know that. The X-rays show air inside your tissues where it shouldn’t be. That indicates a certain kind of infection from strains of bacteria that can be harder to treat than the ordinary kind. It’s probably caused by whatever was on the old wire that you got tangled up in.”

“But you can treat it, right? With the antibiotics?” Todd’s voice was an octave higher than it had been and his face had gone from ruddy to gray. He swayed just a little.

“Sit down right there, Mr. Purcell, and I’ll finish telling you what we’re going to do.” Glenn pointed to the plastic chair next to the bed and Todd Purcell dropped into it with a thud.

Todd repeated, “You can treat it—”

“Todd,” Naomi said with gentle firmness, “let the doctor talk.”

Glenn didn’t bother correcting them. Almost everyone she took care of in the ER called her Doc. Everyone in Iraq had too. “We are going to treat you with antibiotics, and Cindy, the nurse you met earlier, will be starting them any minute. But that’s not going to be enough. We need to take you up to the operating room—”

Naomi’s husband gave a little groan. Glenn walked closer to the bed and gripped his shoulder, her gaze still fixed on Naomi, who held hers unwaveringly.

“You’re not going to have to amputate my leg, are you?” Naomi Purcell asked.

“No. We’re going to make an incision and wash out the deeper tissues to help stop the spread of infection. We might have to make several four-or five-inch incisions, but they’ll heal. You’ll have some scars, but it’s early yet, and chances are good your leg will be fine except for that.”

“All right,” Naomi said instantly. “When?”

“Right now. As soon as we can get the antibiotic started, we’ll take you upstairs to the OR.”

“Are you sure you have to do this?” her husband asked, looking like a frightened deer trapped in a thicket of briars.

“I’m sure. I talked to Dr. Rivers about it, and she—”

“Harper Rivers?”

“No, Flannery.”

“Harper takes care of our kids,” he said, some of the color coming back to his face. “Her sister—that’s the surgeon, right?”

“That’s right. She’ll be in charge upstairs.”

“But you’ll be with her, right?” Naomi said.

“Yeah, I will be,” Glenn said, thinking this would probably be her last case with Flannery Rivers.

Chapter Two

Mari had never lived anywhere without bus service. She’d never lived anywhere without malls and movie theaters and takeout. When she was thirteen, she’d gone to one of the big agricultural centers in LA County on a school-sponsored trip, but the miles and miles of row after row of green things had seemed foreign and boring at the time. Looking back, it had probably only been a few hundred acres of lettuce, but she’d been happy to get back to the concrete and city smells she’d grown up with. No buses meant driving, which she could do but had rarely needed to undertake back home when everything was a stop away on the subway, light rail, or bus. Who would drive in the insanity if they didn’t need to?

When she’d arrived at the Albany Airport lugging everything she planned to start a new life with in two suitcases and a taped-up carton of books, she’d rented a car and, following a printout from Google Maps, driven on increasingly narrow, twisting roads through countryside vaguely reminiscent of the fields and green valleys beyond the sprawl of Los Angeles. The farms she passed here, though, were so much smaller and the land so much hillier and the air so much cleaner. Maybe the East Coast seemed so alien because she’d never known anything other than LA. She’d rarely spent much time outside the city, because why would she? Everything that had seemed important growing up was there in the teeming streets—entertainment, shopping, school. Her parents almost never took a vacation—her father was always working in the store, her mother often joining him during the welcome busy stretches, and on the rare times when they weren’t both busy, there was always something going on with one or the other of Mari’s siblings. With barely a year and a half between them all, the after-school sports, clubs, and social events were a never-ending cycle that repeated year after year. Dances and finals and sports practice occupied everyone’s time, and when her mother was too busy with the younger ones, the older ones—the girls at least—stood in for her. Mari’s life had been the family, and she’d never imagined it any differently until everything had changed.