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  “Do you want to vaccinate the calf while we’ve got her in the lot?”

  “Thanks, Gavin, but I think we’ll let them go this time.”

  “When’re you going to start calling me Blaze?”

  “When it becomes your legal name. What are you doing out of school early?”

  “Last hour’s PE, and I didn’t have dress-out clothes, so I told the teacher I’d be good and come straight here if he let me leave early. Why do you have such a fuss with a silly ol’ nickname? Everybody else calls me Blaze.”

  “Good for them. We’ll find you some exercise clothes and shoes tonight.”

  “Guess you know I’ll be sixteen in three weeks.”

  “Yes. What do you want for your birthday?”

  “To quit school.”

  “Sorry, no way. Anything else?”

  “It’ll be legal then. A guy doesn’t have to go after his sixteenth birthday.”

  “He does if he plans to stay here at the ranch.”

  Gavin blinked at Dane. “You mean I have to keep going to school just to stay here?”

  “That’s the deal. Gavin, you’re still bleeding.” An inch-long cut should have stopped bleeding by now, unless it was deeper than it appeared. The end of Gavin’s sleeve was soaked red.

  The teenager pressed his fingers over the wound. “Nobody told me about that rule when I agreed to come here.”

  “You may find there are a lot of things around here nobody told you about.”

  Gavin gave a disgusted grunt.

  “Come on,” Dane said. “Let’s get you to the house and clean your—”

  “Okay, fine, then there’s something else I want for my birthday.”

  “I hope it’s Gordyburgers,” Dane muttered, still aching from the kick.

  “Call me by my chosen name.”

  Dane put a hand on Gavin’s shoulder and nudged him toward the house. “I don’t understand the logic of calling yourself Blaze when you aren’t an arsonist.”

  “Something my daddy taught me.”

  “I thought he was a veterinarian.”

  Gavin gave Dane an impatient look.

  “Sorry. What did your father teach you?”

  “To take the sting out of the name. Beat ’em to the punch.”

  “Did kids at school call you names?”

  “That’s for me to know. Why’re you limping?”

  “Gordy kicked me.”

  “Better get some ice on it.”

  “I plan to.”

  “Come on, you can say it. ‘I plan to, Blaze.’”

  “For three more weeks, your name is Gav or Gavin, take your pick.”

  “Missouri Regional, this is 841, we are currently inbound for your facility….”

  Cheyenne glanced at her watch, groaned, straightened at her desk, still fighting the nausea. “Go away,” she muttered. Twenty more minutes, and Brillhart would be here. Why hadn’t she asked Ardis to call him sooner?

  “…Caucasian female, late twenties, class one trauma from an MVA. Patient’s car was struck in the driver’s side, had to be extricated. Patient is fully immobilized, responsive only to pain. We are attempting to establish IV at this time. BP sixty over forty by—”

  “Coming here?” Ardis exclaimed. “Did you hear that? They’re bringing us a class one.”

  Cheyenne reached for the ambulance radio and keyed the microphone. “Eight-forty-one this is medical control. Divert to University Hospital. We are not a designated trauma facility.”

  “Missouri Regional this is 841, we copy but cannot comply. University and Boone are both on full trauma diversion at this time. ETA of five minutes.”

  Cheyenne pressed the button again. “Eight-forty-one, this is medical control. We roger your last transmission. Please advise of any change in patient’s condition. This is medical control at Missouri Regional out.” She disconnected.

  “Oh, my. What do we do now?” the secretary asked.

  “Advise RT and X Ray we’ve got a hot one coming in fast.” Cheyenne turned in her chair. “Quickly, Deanna.”

  “G-got it, Dr. Allison.” The secretary swallowed and jerked up the telephone.

  Cheyenne nodded to Ardis. “Have Lab get four units of O-negative blood STAT. I want it in this department when the patient arrives. Then attempt to notify the surgeon on call for backup. Let him know what we have.”

  Ardis went to work.

  Cheyenne found the intubation kit in the trauma room and selected the appropriate size ET tubes. What a time to have the flu.

  The radio came alive again. “Missouri Regional, this is 841. Be advised our patient is now in full arrest. I repeat, our patient is in full arrest. Following ACLS protocol. ETA less than two minutes.”

  Cheyenne made eye contact with Ardis. They would do all they could, but the odds were against this patient surviving.

  “Everyone get your protective gear on,” Cheyenne said.

  “I hear the sirens now,” the secretary called.

  “Make sure RT and X Ray are on their way down,” Cheyenne said. “Ardis, check on that blood.” The trauma room was ready. “Aprons, masks, gloves, everyone.”

  Stepping to the window that overlooked the ambulance bay, Cheyenne caught sight of the red-orange-red-orange flash of lights as the van safety-sped into the lot. Tension thickened the air in the Emergency Department.

  “We can do this,” she said. “Get ready.”

  The RT tech came racing down the far end of the corridor pushing her supply cart.

  Ardis hung up the telephone and swung toward Cheyenne. “They’re getting the blood ready, Dr. Allison.”

  “Good. Come with me.” Cheyenne looked for the ER tech. “Rick, you too.” She led the way out to the bay, where the driver was yanking open the back doors of the ambulance.

  The attendants pulled the intubated patient from the vehicle. Cheyenne’s first sight of the patient was the flash of red blood marring a half-naked body—the attendants had stripped her to check for all injuries.

  “Rick, take over compressions,” Cheyenne ordered the tech. “What’s the rhythm?” she asked the attendant, standing back as they wheeled the stretcher toward the door.

  “PEA,” the paramedic said.

  Pulseless electrical activity. No surprise, judging by the apparent blood loss. The patient was unrecognizable.

  “How much fluid have you given?” Cheyenne asked, following them through the door.

  “We’ve only been able to give about a hundred cc’s,” the paramedic replied. “I could only get a twenty-two gauge IV started.”

  Not big enough. “We need at least a twenty gauge.” She turned to Ardis. “I need you to establish a large-bore IV, have her ready for the blood when it arrives.”

  “I’ll get right on it.”

  They helped transfer the patient to the ER trauma bed while the respiratory tech took over bagging the patient, helping her breathe. Cheyenne moved to the patient’s left side to check for placement of the ET tube, leaving her right side accessible to Ardis.

  No breath sounds over the abdomen. Good. That meant the patient had been intubated properly. Pressing the bell of the stethoscope over the patient’s bloody chest, she raised a hand for Rick to delay the next compression.

  No heartbeat.

  She nodded for him to continue.

  As she removed the stethoscope from the patient’s rib cage, she saw a dark blotch on the skin. A large birthmark just below the left breast.

  She looked at the face again, reached for the blood-matted hair.

  Black. It was the length of…

  She looked at the paramedic. “You said she was the driver?”

  “Only person in the car. We pulled her from beneath the steering wheel.”

  Cheyenne couldn’t catch her breath. “And the car? Did you notice what kind…?”

  “Dark blue Sable sedan.”

  The edges of Cheyenne’s vision went black and she felt herself slipping backward. It can’t be—I told her not t
o drive, she said she wouldn’t….

  “Dr. Allison!” Ardis yelled.

  “Oh, Susan. Oh, please God, no.” Cheyenne fought to regain her composure. “Where’s that blood!” she snapped.

  “Right here,” Ardis said. “Hold on, Dr. Allison, I can’t get the large bore IV.”

  “Have you heard from the surgeon?”

  It couldn’t be Susan. She was only going to a neighbor’s house.

  But her sister’s silhouette—the undamaged part—was obvious now.

  “Our on-call surgeon is also on trauma call for University,” Deanna said. “We’re trying to reach someone else, but—”

  “Ardis, get me a central line kit,” Cheyenne ordered. “She needs blood now. And get X Ray in here for a trauma series. Now!”

  “Dr. Allison?” came a voice from the hallway. It was her replacement. Jim Brillhart. His tall, lean form filled the doorway. “How can I help?”

  She looked up at him, felt the floor rock beneath her.

  He rushed forward and caught her arm. “Are you okay?”

  “I’m getting ready to do a central line on this patient. I’ll take the jugular so I won’t interfere with CPR.”

  “You want me to do it?”

  “I’ll be fine.” She refocused on her procedure, felt the sweat coat her neck and chest and trickle down the sides of her face as she tried to keep her hands steady

  A tech reported on the CBC and Cheyenne prepared for a transfusion as the respiratory tech came into the crowded room with a report on Susan’s blood gas that deepened Cheyenne’s frown.

  “That could be venous,” she said. They missed the artery and got a vein. “Take it again.”

  “Dr. Allison, I really don’t think it’s—”

  “One more time.”

  The X-ray tech brought in the trauma X-ray series and mounted them on the view box.

  It showed multiple left rib fractures with a massive collection of blood in the left chest cavity. Multiple pelvic fractures with a ground glass appearance on the X ray.

  No, Susan. No!

  “Get me a chest-tube setup. And wrap a sheet around her pelvis and tighten it as much as you can.”

  Rick looked up from his compressions, though he continued in perfect rhythm. “You want me to stop doing compressions when you put in the chest tube?”

  “Yes, but no longer than absolutely necessary. Get somebody fresh to spell you.”

  “Let me do the chest tube,” Jim said, “then I’ll take over for Rick.”

  “Check for fine V fib,” Cheyenne said as he placed the tube. Susan, baby, work with me. Don’t you dare die on me!

  The monitor remained an agonal rhythm, but it now appeared more asystole.

  Flatline.

  No! She would not let that happen!

  “Where’s that surgeon? I need him now.”

  “I’m sorry, Dr. Allison, but he’s already been called to University Hospital for disaster code,” Deanna said.

  “Then it’s up to us,” Cheyenne said. “Get me a thoracotomy tray.”

  Jim looked at her in surprise. “Cheyenne, are you sure about this?”

  “Push the epinephrine, Ardis,” Cheyenne said, ignoring him. The thought of opening Susan’s chest and massaging her heart was unthinkable. But it was her sister’s only chance.

  “Ardis! Epi. Now.”

  “Dr. Allison,” Jim said.

  “I’ve got to try it,” she said softly. “This is my sister.”

  He gave a shocked, “Oh, dear God no,” then, “Rick, take over back here.” Jim came around the bed to Cheyenne, placed a hand on each shoulder and tried to draw her away from the bed.

  She resisted. “I’m still the doctor in charge, Jim. You can’t take me off this case.”

  “I’m your director, Cheyenne, and your friend. Listen to me for a moment.”

  She looked up at him. “Did you hear me? It’s my sister!”

  “I know, but what if it weren’t? What would you do?”

  She turned again to Susan’s side.

  “She’s a blunt trauma victim, right?”

  “That’s right, Dr. Brillhart,” said the paramedic.

  “Pulseless for more than twenty minutes?”

  “Twenty-five,” Rick said.

  “Cheyenne,” Jim said gently. “You need to let her go.”

  “I can’t do that. Ardis, push the epinephrine again.”

  “You’ve done all you can,” Jim said.

  No! I’m still in charge! “I haven’t called this code yet.”

  “Cheyenne.” Jim leaned closer. He placed a hand over hers.

  She jerked away. “Ardis, why are you waiting? Push the epi! Any word on the second blood gas?”

  “Dr. Allison,” Jim said, this time with authority. “You have to call it. She’s gone. She wouldn’t want to come back, even if she could. There’s too much damage.”

  Cheyenne felt the dizziness strike once more with blinding swiftness. She couldn’t bear it.

  “I can’t call it,” she whispered.

  “I’ll do it, then,” Jim said.

  “No!”

  Silence descended except for the sounds of the monitor, Rick’s labored breathing and the efforts that kept this hopelessly damaged body functioning.

  Let her go? She’s already gone.

  Cheyenne looked at her watch, then reached for Susan’s hand, covered in blood.

  Everyone waited.

  I’m so sorry, my baby sister.

  “Time of…” Cheyenne swallowed, took a breath of air, which was strong with the scent of blood. “Time of…death, 18:14.”

  Rick stopped compressions. The respiratory tech stopped bagging. Ardis set her equipment down and rushed around the bed to Cheyenne’s side.

  As Cheyenne felt herself falling, felt hands catching her, she willed herself to descend into death with her sister.

  Chapter Four

  Dane found Cook in the pantry, sorting through institutional cans of tomato soup.

  “Barbecue tonight?” he asked the bony old ranch hand.

  “If I can find the molasses,” Cook said over his shoulder.

  “If we’re out, I’ll make a run to town.” The boys loved that recipe. “Cook, did Blaze get into the medicine chest?”

  The older man turned and frowned at him. “Why would he do that?”

  “He had an injury out in the barn lot. Gordy got after us.”

  “That blamed ol’ cow’s going to get somebody kilt someday. Since when did you start calling him Blaze?”

  Oops. “Since three seconds ago. I’d better go see about him.”

  Dane took the stairs and saw a spot of blood on the railing. He went to the closed door of the bedroom Gavin and Willy shared. When he pushed it open he saw Gavin in the center of the room, holding the end of a syringe against the bare flesh of his stomach.

  “What are you doing?”

  “I’m a bleeder.” The boy wiped a smudge of blood from his arm.

  “What’s in the syringe?”

  “A coagulant to stop the flow.” He rewrapped the syringe and set it on the top of his dresser.

  “Nobody told me,” Dane said.

  “Not a lot of people know.”

  “How could you keep something like that a secret?”

  “You don’t believe me?” Again, that expression of irritable impatience, thick brows lowered over eyes narrowed with disappointment.

  “I didn’t say that.”

  Gavin sat on the chest in front of the window that overlooked the barn. “About two years ago my old doctor died, and nobody took his place. The guy was in his eighties, only had a few patients. My prescription for this stuff’s always refillable, so I didn’t go to a new doc for a while. When I did, he never said anything about sending him my old records. I guess they kind of got lost.”

  “That’s dangerous, Blaze. You need to take responsibility for your own health care now. What would happen if you ran out—”

  “What’d
you call me?”

  Oh, no. He’d done it again.

  “You called me Blaze.”

  “Happy birthday. Why didn’t your mother tell the social worker about your condition?”

  “She doesn’t know.”

  “I can’t believe she wouldn’t—”

  “There you go again.” Blaze shook his head and gestured toward the bed. “You want to sit down and let me tell you a few facts of life?”

  “I want to know where Clint can get a copy of your medical records.”

  Blaze unwrapped a paper towel from around his wrist. “See? The stuff’s already working. No big deal.”

  “It’s a big deal when we don’t know—”

  “Thing is, I didn’t figure they’d let me come to the ranch if they knew I was a bleeder. You know, working with the animals can be a little tricky sometimes. But I’ve got this—” his voice wavered “—this need to be around….” He swallowed and studied the wound on his wrist.

  “It’s okay,” Dane said. “I think I understand. You probably worked with your father a lot in his practice.”

  “All the time.”

  “You lived in Rolla?”

  “Edge of town. Saw my mother maybe three times after the divorce was final, and maybe six times before that. Until Dad died.”

  “I’m sorry.”

  “About what? That my own mother doesn’t want me? Not your fault. You ever put any ice on that thigh?”

  “I will.”

  “Sure. You gonna kick me out?”

  “You got any other secrets you need to tell me?”

  “I’m not an arsonist.”

  “That’s no secret.”

  “I don’t think I’ll make it at school.”

  Dane eased himself onto the bed at last, groaning at the increased soreness of his leg. “Why not?”

  “Don’t read too well.”

  “You need glasses?”

  “I’ve got good vision, I just can’t catch on to reading.”

  “Maybe I can help you.”

  “How’re you going to do that?”

  “Has anybody ever suggested you might have a learning disability?”

  “All my life.”

  “Your father could have helped you—”

  “Don’t you say anything about my father,” Blaze snapped. “He got dumped by the same woman who dumped me. He did the best he could, but he was busy.”