Tess Gerritsen - Ice Cold

Doug rose to his feet. “We’ll let you rest, okay? Grace, you stay here with him.” He looked at Maura and Elaine. “Let’s go in the other room.”

They met in the kitchen. Elaine had left a pot of water to heat on the woodstove, and it was now simmering, ready to sterilize instruments. Through the steam-fogged window, Maura could see the sun was already dropping toward the horizon.

“You can’t force him to go through this,” said Maura.

“It’s for his own good.”

“Surgery without anesthesia? Think about it, Doug.”

“Give the Valium some time to work. He’ll calm down.”

“But he won’t be unconscious. He’ll still be able to feel the incision.”

“He’ll thank us for it later. Trust me.” Doug turned to Elaine. “You agree with me, don’t you? We can’t just give up on his leg.”

Elaine hesitated, obviously torn between the two terrible options. “I don’t know…”

“Ligating the artery is the only way we’ll be able to remove that tourniquet. The only way we can restore some blood flow.”

“Do you really think you can do it?”

“It’s a straightforward procedure. Maura and I both know the anatomy.”

“But he’ll be moving around,” said Maura. “There could be a lot more blood loss. I don’t agree with this, Doug.”

“The alternative is to sacrifice the limb.”

“I think the limb is already a lost cause.”

“Well, I don’t.” Doug turned back to Elaine. “We need to vote on this. Do we try to save his leg or not?”

Elaine took a breath and nodded. “I guess I’m with you.”

Of course she would be. Arlo was right. She always sides with Doug.

“Maura?” he asked.

“You know what I think.”

He glanced out the window. “We don’t have a lot of time. We’re losing our daylight and I’m not sure we’ll be able to see enough with the kerosene lamp.” He looked at Maura. “Elaine and I both vote to go ahead with this.”

“You forgot a vote. There’s Arlo’s, and he made it pretty clear what he wants.”

“He’s not competent to make any decisions right now.”

“It’s his leg.”

“And we can save it! But I need your help. Maura, I can’t do it without you.”

“Dad?” Grace was standing in the kitchen doorway. “He doesn’t look so good.”

“What do you mean?”

“He’s not talking anymore. And he’s snoring really loud.”

Doug nodded. “The drugs must have kicked in. Let’s get some instruments boiling. And we’ll need needles. A spool of thread.” He looked at Maura. “Are you with me or not?”

It doesn’t matter what I say, she thought. He’s going to do it anyway.

“I’ll see what I can find,” she said.

IT TOOK THEM an hour to collect and sterilize all the items they’d managed to scavenge. By then, the window admitted only a weak afternoon glow. They lit the kerosene lamp, and by the light of the hissing flame, Arlo’s eyes were sunken in shadow, as though his soft tissues were collapsing, his body consuming itself. Doug peeled back the blanket, releasing the sharp smell of the urine-saturated rug.

The leg was as pale as a shank of cold meat.

No amount of scrubbing could cleanse all the bacteria from their hands, but Doug and Maura tried anyway, lathering and rinsing until their skin was raw. Only then did Doug reach for the blade. It was a paring knife, the most delicate one they could find, and they had sharpened it before sterilizing. As he knelt over the leg, the first hint of uncertainty flickered in his eyes. He glanced up at Maura.

“Ready to release the tourniquet?” he said.

“You haven’t tied off the artery yet,” said Elaine.

“We need to identify which artery it is. And the only way is to see where he’s bleeding. You need to hold him still, Elaine. Because he’s going to wake up.” He glanced at Maura and nodded.

She barely loosened the tourniquet and a spurt of blood exploded from the wound, splattering Doug’s cheek.

“It’s the anterior tibial,” said Doug. “I’m sure of it.”

“Tighten the belt!” Elaine said, panicking. “He’s bleeding too much!”

Maura refastened the tourniquet and looked at Doug. He took a breath and began to cut.

At the first slice of the knife, Arlo jolted awake with a scream.

“Hold him! Hold him still!” Doug yelled.

Arlo kept screaming, battling them away, the tendons on his neck so taut they looked ready to snap. Elaine wrestled his shoulders back to the floor, but she could not stop him from thrashing and kicking at his torturers. Maura tried to pin his thighs, but blood and sweat had made his bare skin slippery, so she threw her weight across his hips. Arlo’s scream rose to a shriek that penetrated straight to her bones, a shriek so piercing it felt as if the sound were coming from her own body, as if she were screaming as well. Doug said something, but she couldn’t hear him through that scream. Only when she glanced up did she see that he had set down the knife. He looked exhausted, his face gleaming with sweat even in that cold room.

“It’s done,” he said. Rocking back on his knees, he wiped his sleeve across his forehead. “I think I got it.”

Arlo gave an agonized sob. “Fuck you, Doug. Fuck all of you.”

“Arlo, we had to do it,” said Doug. “Maura, loosen that tourniquet. Let’s see if we got the bleeding controlled.”

Slowly Maura released the belt, half expecting to see another gush of blood. But there was no trickle, not even a slow ooze.

Doug touched Arlo’s foot. “The skin’s still cool. But I think it’s starting to pink up.”

She shook her head. “I don’t see any perfusion.”

“No, look. It’s definitely changing color.” He pressed his palm against the flesh. “I think it’s warming up.”

Maura frowned at skin that looked every bit as dead and pale as it had before, but she said nothing. It made no difference what she thought; Doug had convinced himself that the operation was a success, that they’d done exactly what they should have. That everything was going to be fine. In Doug’s world, everything always turned out fine. So be bold, jump out of planes, and let the universe take care of you.

At least the tourniquet was now off. At least he was no longer bleeding.

She rose to her feet, the sour stink of Arlo’s sweat on her clothes. Exhausted by his ordeal, Arlo was now quiet and drifting to sleep. Massaging her aching neck, she went to the window and stared out, relieved to turn her attention to something else, anything else but their patient. “It’s going to be dark in an hour,” she said. “We can’t get out of here now.”

“Not in the Jeep,” said Doug. “Not with that broken tire chain.” She could hear him rattling through all the pill bottles. “We have enough Percocet to keep him comfortable for at least another day. Plus Elaine says she has codeine in her purse, if I can just find it.”

Maura turned from the window. Everyone looked as drained as she felt. Elaine sat slumped against the couch. Doug was staring listlessly at the array of pill bottles. And Grace-Grace had long ago fled the room.

“He needs to get to a hospital,” said Maura.

“You said you’re expected back in Boston tonight,” said Elaine. “They’ll be searching.”

“The problem is, they won’t know where to look.”

“There was that old guy in the gas station. The one who sold you the newspaper. He’ll remember us. When he hears you’re missing, he’ll call the police. Eventually someone’s going to show up here.”

Maura looked down at Arlo, who had sunk back into unconsciousness. But not soon enough for him.

WHAT DID YOU WANT TO SHOW ME?” ASKED DOUG.