Tess Gerritsen: Harvest

Vince shoved open the car door and climbed out of the driver's seat.

"Where you going?" asked Chuck.

"T'get some more."

"You can't handle no more."

"Fuck you," said Vince, and stumbled across the parking lot towards the 7-11's front door.

Chuck laughed. "You can't even walk!" he yelled out the window. Asshole, thought Vince. What the fuck, he could walk. See, he was walking fine. He'd just stroll into the 7-11 and pick up two more sixes. Maybe three.Yeah, he could do three, easy. His stomach was iron, and except for having to piss every few minutes, he didn't feel the effects at all.

He tripped going in the door — goddamn high threshold, they could get sued for that — but he picked himself right up. He got three six packs from the cooler and swaggered over to the cash register. He plunked down a twenty-dollar bill.

The clerk looked at the money and shook his head. "Can't take it," he said.

"What do you mean, can't take it?"

"Can't sell beer to an intoxicated customer."

"Are you saying I'm drunk?"

"That's right."

"Look, it's money, isn't it?You don't want my fucking money?"

"I don't wanna get sued. You just put the beer back, son, OK? Better yet, why don't you buy a cup of coffee or something? A hot dog."

"I don't want a fucking hot dog."

"Then just walk on out, boy. Go on."

Vince shoved one of the six packs across the countertop. It slid off the edge and crashed to the floor. He was about to launch another six pack off the counter when the clerk pulled out a gun.

Vince stood staring at it, his body poised in mid-shove.

"Go on, get the hell out," said the clerk.

"OK?Vince stepped back, both hands raised in submission. "OK, I hear you."

He tripped on the damn threshold again as he went out the door.

"So where is it?" asked Chuck as Vince climbed back in the car. "They're outta beer."

"They can't be out of beer."

"They're fucking out, OK?Vince started the car and goosed the accelerator. They squealed out of the lot.

"Where we going now?" asked Chuck.

"Find another store." He squinted ahead at the darkness. "Where's the onramp? Gotta be around here somewhere."

"Man, give it up. No way you'll go another round without puking." "Where's the fucking onramp?"

"I think you passed it."

"No, there it is." Vince veered left, tyres squealing over the pavement.

"Hey," said Chuck. "Hey, I don't think-'

"Got twenty fucking bucks left to blow. They'll take it. Someone'll take it."

"Vince, you're going the wrong way!"

"What?"

Chuck yelled, "You're going the wrong way!"

Vince gave his head a shake and tried to focus on the road. But the lights were too bright and they were shining right in his eyes. They seemed to be getting brighter.

"Pull right!" screamed Chuck. "It's a car! Pull right!" Vince veered right. So did the lights.

He heard a shriek, unfamiliar, unearthly.

Not Chuck's, but his own.

Dr. Abby DiMatteo was tired, more tired than she'd ever been in her life. She had been awake for thirty straight hours, if one didn't count her ten-minute nap in the X-ray lounge, and she knew her exhaustion showed. While washing her hands in the SICU sink, she had glimpsed herself in the mirror and had been dismayed by the smudges of fatigue under her dark eyes, by the disarray of her hair, which now hung in a tangled black mane. It was already 10 a.m., and she had not yet showered or even brushed her teeth. Breakfast had been a hardboiled egg and a cup of sweet coffee, handed to her an hour ago by a thoughtful surgical ICU nurse. Abby would be lucky to find time for lunch, luckier still to get out of the hospital by five and home by six. Just to sink into a chair right now would be luxury.

But one did not sit during Monday morning attending rounds. Certainly not when the attending was Dr. ColinWettig, Chairman of Bayside Hospital's Surgical Residency Programme. A retired Army general, Dr. Wetrig had a reputation for crisp and merciless questions. Abby was terrified of the General. So were all the other surgical residents.

Eleven residents now stood in the SICU, forming a semicircle of white coats and green scrub suits. Their gazes were all trained on the residency chairman. They knew that any one of them could be ambushed with a question. To be caught without an answer was to be subjected to a prolonged session of personalized humiliation.

The group had already rounded on four post-op patients, had discussed treatment plans and prognoses. Now they stood assembled beside SICU Bed 11. Abby's new admission. It was her turn to present the case.

Though she held a clipboard in her arms, she did not refer to her notes. She presented the case by memory, her gaze focused on the General's unsmiling face.

"The patient is a thirty-four-year-old Caucasian female, admitted at one this morning via the trauma service after a high-speed head-on collision on Route 90. She was intubated and stabilized in the field, then airlifted here. On arrival to the ER, she had evidence of multiple trauma. There were compound and depressed skull fractures, fractures of the left clavicle and humerus, and severe facial lacerations. On my initial exam, I found her to be a well nourished white female, medium build. She was unresponsive to all stimuli with the exception of some questionable extensor posturing-'

"Questionable?" asked Dr. Wetfig. "What does that mean? Did she or did she not have extensor posturing?"

Abby felt her heart hammering. Shit, he was already on her case. She swallowed and explained, "Sometimes the patient's limbs would extend on painful stimuli. Sometimes they wouldn't."

"How do you interpret that? Using the Glasgow Coma Scale for motor response?"

"Well. Since a nil response is rated a one, and extensor posturing is a two, I suppose the patient could be considered a… one and a half."

There was a ripple of uneasy laughter among the circle of residents.

"There is no such score as a one and a half," said Dr. Wettig.

"I'm aware of that," said Abby. "But this patient doesn't fit neatly into-'

"Just continue with your exam," he cut in.

Abby paused and glanced around at the circle of faces. Had she screwed up already? She couldn't be sure. She took a breath and continued. "Vital signs were blood pressure of ninety over sixty and pulse of a hundred. She was already intubated. She had no spontaneous respirations. Her rate was fully supported by mechanical ventilation at twenty-five breaths per minute."

"Why was a rate of twenty-five selected?"

"To keep her hyperventilated."

"Why?"

"To lower her blood carbon dioxide. That would minimize brain edema."

"Go on."

"Head exam, as I mentioned, revealed both depressed and compound skull fractures of the left parietal and temporal bones. Severe swelling and lacerations of the face made it difficult to evaluate facial fractures. Her pupils were midposition and unreactive. Her nose and throat-' "Oculocephalic

"reflexes?"

"I didn't test them."

"You didn't?"

"No, sir. I didn't want to manipulate the neck. I was concerned about possible spinal dislocation."

She saw, by his slight nod, that her answer had been acceptable.

She described the physical findings. The normal breath sounds. The unremarkable heart. The benign abdomen. Dr. Wettig did not interrupt. By the time she'd finished describing the neurologic findings, she was feeling more self-assured. Almost cocky. And why shouldn't she? She knew what the hell she'd been doing.

"So what was your impression?" asked Dr. Wettig. "Before you saw any x-ray results?"

"Based on the midposition and unreactive pupils," said Abby, "I felt there was probable midbrain compression. Most likely from an acute subdural or epidural haematoma." She paused, and added with a quiet note of confidence, "The CT scan confirmed it. A large left-sided subdural with severe midline shift. Neurosurgery was called in. They performed an emergency evacuation of the clot."