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Chapter One
The Pittsburgh city hospital ambulance crested a hill, its pulsing lights and shrill siren cutting through the night sky. The EMT behind the wheel, Michele Wilkes, maneuvered the ambulance through the traffic, swerving left then right. Despite the noise and action around her, Wilkes's eyes never left the road—a discipline her years on the job had made instinctive. This late on a Friday night, she knew she had to be especially careful. Wilkes pulled her radio microphone off its rack and switched it on.
"We're en route with a mate cardiac, age sixty-two. Estimated time of arrival, twelve minutes," she said, keeping the message short.
The dispatcher responded in kind.
"Copy, ETA in twelve. Crash unit standing by."
Wilkes allowed herself a glance in the rearview mirror.
"How's he looking, Leonard?"
Wilkes's senior partner, Leonard Betts, was hunched over an elderly black man in the back of the ambulance, simultaneously checking his heartbeat with a stethoscope and a digital heart monitor.
"He's up to his ass in alligators," Betts answered calmly.
Just as he spoke, the monitor emitted a series of short, piercing beeps. The patient gasped loudly, then began gulping for air. Wilkes could hear the monitor going crazy.
"Is he going into arrest?" she shouted.
Ignoring the question, Betts pulled off the stethoscope and put his ear to the man~s chest. Satisfied with what he heard, Betts called back to Wilkes. "No, he's not."
Betts reached back into a drawer and pulled out a large hypodermic syringe. Shucking its plastic sleeve and removing the safety tip, Betts jabbed it into the man's windpipe..Instantly, air whistled out through the barrel, and the monitor resumed a steady rhythm. The patient's breathing returned to normal.
Wilkes heard the monitor's calm beeping from the cab and wondered what had just happened.
"What'd you do?" she asked her partner.
Moving efficiently, Betts taped down the syringe. He remained vigilant as he briefed Wilkes.
"Aspirated his chest," he explained. "He has a tension pneumothorax pressing on his heart. It just looked like a cardiac."
Wilkes shook her head, quietly impressed. It never ceased to amaze her that, no matter how dire the situation, Leonard sounded like he was treating a stubbed toe.
"Nice catch," she said, keeping her eyes on the road. "How did you know?"
Betts stared hard at his unconscious patient, looking the man over as if he could almost see through the skin. Finally, he murmured, "Because he's dying of cancer. It's eaten through one lung already."
Wilkes was keenly aware of the equipment available to EMTs in an ambulance. There was no way Leonard could tell this at this point.
"How do you know, Leonard?" she shook her head in wonder.
But Betts didn't answer. He continued to stare into the man's chest. Wilkes turned her head to look back at him for a moment. She wanted to know how he did it, how he always knew ahead of time what doctors at the hospital would confirm hours later. With her head turned, she didn't notice the stoplight ahead of her change from green to red.
The sound of a car horn caused Wilkes to whip her head around. The tow truck's headlights caught the side of her face an instant before the vehicle plowed into her. The violence of the crash shattered metal and flesh like a bomb blast. The ambulance, which had been cruising north, was slammed sideways by the truck, sending it sliding in a shower of broken glass before it crashed into a streetlamp that buckled halfway up. The top section of the streetlamp teetered, then fell down onto the wreckage, illuminating the cab of the tow truck where the driver lay stumped over the wheel, his horn still blaring.
Dazed but conscious, Wilkes pushed the ambulance door open and stumbled out. Blood dripped onto her uniform from a wound on her forehead. She steadied herself by holding on to the mangled door of the ambulance.
"Leonard?" she called out, but there was no answer. Other than the tow truck's horn, the deserted downtown street was quiet as a tomb.
Wilkes picked her way to the back of the ambulance and found the back doors hanging wide open. Nervously, she looked inside, where she discovered the patient lying dead, strapped to a blood-spattered gurney that had flipped over on its side. The heart monitor showed a blue flatline shimmering across its screen. All the medical equipment—the bandages, bottles, pumps, IV bags—had been thrown around the compartment by the impact. But Wilkes still didn't see her partner.
"Leonard!" she yelled.
She turned from the wreckage and scanned the scene. Eventually her eyes fell on a pair of legs stretched out along the sidewalk thirty or forty feet away. A row of newspaper racks concealed the body from the waist up. Wilkes staggered toward the limbs, ducking underneath a utility pole cable, and making her way around the racks. As she did, the rest of the body came into view.
Most of it, anyway.
A wave of nausea hit Wilkes, and she had to cover her mouth to keep from vomiting. She stumbled, then braced herself against one of the newspaper racks and forced herself to look again. Leonard Betts's blue-and-white uniformed body sprawled before her, lying stomach down in a pool of blood that spurted from the stump of hi neck.
"Oh, God. Leonard!" Wilkes cried, her body shuddering helplessly.
Then she saw it, just a few feet away, lodged between a car tire and the curb. Leonard Betts's eyes, frozen open, stared back at her from his severed head.
Michele Wilkes stood in the doorway of the Monongahela Medical Center morgue. She watched as a night attendant lifted a sheet from the body of the patient she was supposed to deliver to the emergency ward five hours earlier. Now, instead of resting in a recovery room, the man lay on the stainless-steel drawer of a morgue freezer. The attendant swiftly slid the corpse into the compartment and slammed the door shut, the latch clicking shut with what struck Wilkes as appropriate finality.
