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  In silence she approached the kitchen table. Her vision suddenly blurred with tears as she gazed at the Sara Lee layer cake he had taken out of the freezer. Flames danced atop eleven candles.

  Noah struck another match and lit the twelfth flame on the cake. “Happy birthday, Dad,” he said softly.

  Happy birthday, Peter, she thought, and blinked away her tears.

  And she and her son blew out the candles.

  4

  Mrs. Horatio was going to pith a frog.

  “It doesn’t hurt them a bit, once you’ve penetrated their brain stem,” she explained. “The needle goes in at the base of the skull, and you wiggle it around a little to destroy all the sensory tracts running up to the brain. This paralyzes them, stops any conscious movement, but it keeps their spinal reflexes intact for study.” She reached into the jar and picked up a squirming frog in one hand. With her other hand, she reached for the pithing needle. It was humongous.

  Though a ripple of nausea stirred in his stomach, Noah sat perfectly still at his desk in the third row. He was careful to keep his legs casually thrown out in front of him, his expression bored.

  He could hear the other students squirm in their chairs, the girls mostly. To his right, a horrified Amelia Reid covered her mouth with her hand.

  He let his gaze slide around the room and he silently pronounced judgment as he looked at each student in turn. Nerd. Jock. Kiss-ass preppie. Except for Amelia Reid, none of them were kids he cared to hang out with. None of them were interested in hanging out with him, either, but that was okay. His mom might like it in this town, but he didn’t plan on staying forever.

  Graduate, and then I’m outta here, outta here, outta here.

  “Taylor, stop fidgeting and pay attention,” said Mrs. Horatio.

  Noah glanced sideways, and saw that Taylor Darnell was gripping his desk with both hands and staring at the exam paper he’d just gotten back that morning. Mrs. Horatio had scrawled a giant D plus in red marker. The test paper was covered with Taylor’s angry slashes in black ink. Next to the humiliating grade, he’d written: “Die, Mrs. Whoratio.”

  “Noah, are you paying attention?”

  Noah flushed and turned his gaze back to the front of the class. Mrs. Horatio was holding up the frog for all to see. She actually looked like she was enjoying herself as she placed the tip of the pithing needle against the back of the frog’s head. Her eyes were bright, her mouth puckered and eager as she jammed the needle into the brainstem. The frog’s hind legs thrashed, its webbed feet slapping in pain.

  Amelia gave a whimper and dropped her head down, her blond hair cascading over the desk. Chairs were squeaking all over the room now. Someone called out with a note of desperation: “Mrs. Horatio, can I be excused?”

  “… have to move the needle back and forth with a certain amount of force. Don’t worry about the feet flapping around like this. It’s purely reflex action. Just the spine shooting off impulses.”

  “Mrs. Horatio, I have to use the bathroom …”

  “In a minute. First, you have to see how I do this.” She twisted the needle and there was a soft crack.

  Noah thought he was going to puke. Struggling to maintain that look of utterly cool nonchalance, he turned away, his hands clenched under his desk. Don’t puke, don’t puke, don’t puke. He focused on Amelia’s blond hair, which he’d often admired. Rapunzel hair. He stared at it, thinking how much he’d like to stroke it. He’d never even dared talk to Amelia. She was like a girl in a golden bubble, beyond the reach of any mere mortal.

  “There now,” said Mrs. Horatio. “That’s all there is to it. You see, class? Total paralysis.”

  Noah forced his gaze back to the frog. It lay on the teacher’s desk, a limp, flappy carcass. Still alive, if you believed old Horatio, but showing no signs of it. He felt a sudden and overwhelming pity for that frog, imagined himself sprawled across that desk, eyes open and aware, body unresponsive. Darts of panic going nowhere, just exploding like firecrackers in your brain. He himself felt paralyzed and numb.

  “Now each of you pair up with a lab partner,” said Mrs. Horatio. “And scoot your desks together.”

  Noah swallowed and looked sideways at Amelia. She gave a helpless nod.

  He moved his desk next to hers. They didn’t speak to each other; it was a partnership based purely on proximity, but hey, whatever it took to get up close. Amelia’s lips were trembling. He wanted very much to comfort her, but he didn’t know how to, so he just sat there, his face assuming, by default, its usual bored expression. Say something nice to her, moron. Something to impress her. You may never get another chance!

  “Frog sure looks dead,” he said.

  She shuddered.

  Mrs. Horatio came walking down the aisle carrying the jar of frogs. She stopped beside Noah and Amelia.

  “Take one. Each team works on a frog.”

  The blood drained from Amelia’s face. It was up to Noah.

  He shoved his hand in the jar and grabbed a wriggling frog. Mrs. Horatio slapped a pithing needle down on his desk. “Get started, you two,” she said, and moved on to the next team.

  Noah looked down at the frog he was holding. It stared back at him, bug-eyed. He picked up the pithing needle, then he looked at the frog again. Those eyes were begging him, Let me live, let me live! He put down the needle, his nausea back full force, and looked hopefully at Amelia. “You wanna do the honors?”

  “I can’t,” she whispered. “Don’t make me, please.”

  One of the girls screamed. Noah glanced sideways and saw Lydia Lipman leap out of her chair and scramble away from her lab partner, Taylor Darnell. There was a wooden thud, thud, thud, as Taylor stabbed his pithing needle into the frog. Blood spattered on his desk.

  “Taylor! Taylor, stop it!” said Mrs. Horatio.

  He kept stabbing. Thud, thud. The frog looked like green hamburger. “D plus,” he muttered. “I studied all week for that test. You can’t give me a D plus!”

  “Taylor, go to the principal’s office.”

  He stabbed the frog harder. “You can’t give me a lousy D plus!”

  She grabbed his wrist and tried to take the needle away from him. “Go see Miss Cornwallis now!”

  Taylor yanked away, knocking the dead frog off his desk. It tumbled into Amelia’s lap. With a shriek, she jumped to her feet and the small corpse splatted to the floor.

  “Taylor!” Mrs. Horatio yelled. Again she grabbed his wrist, this time forcing him to drop the pithing needle. “Leave this room immediately!”

  “Fuck you!”

  “What did you say?”

  He stood up and shoved his chair to the floor. “Fuck you!”

  “You are suspended as of right now! You’ve been sullen and disrespectful all week. This is it, buddy. You’re out of here!”

  He kicked the chair. It bounced up the aisle and crashed into a desk. Grabbing his shirt, she tried to march him toward the door, but he twisted free and shoved her backwards. She fell against a desk, toppling the jar. It shattered, and frogs leaped free, scattering away in a writhing carpet of green.

  Slowly Mrs. Horatio rose to her feet, fury blazing in her eyes. “I’m going to have you expelled!”

  Taylor reached into his backpack.

  Mrs. Horatio’s gaze froze on the gun in his hand. “Put it down,” she said. “Taylor, put it down!”

  The explosion seemed to punch her in the abdomen. She staggered backwards, clutching her belly, and dropped to the floor with a look of disbelief. Time seemed to halt, frozen for one interminable moment as Noah stared down in horror at the bright river of blood streaming toward his sneakers. Then a girl’s terrified shriek pierced the silence. In the next instant, chaos exploded all around him. He heard chairs slam to the floor, saw a fleeing girl stumble and fall to her knees in the broken glass. The air itself seemed misted with blood and panic.

  Another gunshot exploded.

  Noah’s gaze swept around in a slow-motion pan of fleeing bodies
, and he saw Vernon Hobbs tumble forward and crash into a desk. The room was a blur of flying hair and churning legs. But Noah himself could not seem to move. His feet were mired in a waking nightmare, his body refusing to obey his brain’s commands of Run! Run!

  His gaze panned back across the chaos to Taylor Darnell, and to his horror he saw that the gun was now pointed at Amelia’s head.

  No, he thought. No!

  Taylor fired.

  A streak of blood magically appeared on Amelia’s temple and the rivulet slowly dripped down her cheek, yet she remained standing, her eyes wide and focused like a condemned animal’s on the gun barrel. “Please, Taylor,” she whispered. “Please, don’t …”

  Taylor raised the gun again.

  All at once, Noah’s legs broke free of their nightmare paralysis, his body moving of its own accord. His brain registered a multitude of details at once. He saw Taylor’s head come up, face rotating toward Noah. He saw the gun slowly sweep around in an arc. He saw the look of surprise in Taylor’s eyes as Noah came flying at him.

  Another bullet exploded out of the barrel.

  “I’ve just noticed my patient was admitted. Why didn’t anyone call me?”

  The ward clerk looked up from her desk and seemed to shrink when she saw it was Claire asking the question. “Uh … which patient, Dr. Elliot?”

  “Katie Youmans. I saw her name posted on one of the doors, but she’s not in the room. I can’t find her chart in the rack.”

  “She was admitted just a few hours ago, through the ER. She’s in X-ray right now.”

  “No one notified me.”

  The clerk’s gaze dropped like a stone to her desk. “Dr. DelRay’s taken over as attending physician.”

  Claire absorbed this dismaying news in silence. It was not uncommon for patients to switch physicians, sometimes for the most trivial of reasons. Two of Adam DelRay’s patients had transferred to Claire’s practice as well. But she was surprised that this particular patient would choose to leave her care.

  Sixteen years old, and mildly retarded, Katie Youmans had been living with her father when she was brought in to see Claire for a bladder infection. Claire had noticed at once the circumferential bruises on the girl’s wrists. Forty-five minutes of gentle questioning and a pelvic examination had confirmed Claire’s suspicions. Katie was removed from her father’s abusive household and placed in foster care.

  Since then, the girl had thrived. Her bruises, both physical and emotional, finally faded. Claire had counted Katie as one of her triumphs. Why would the girl switch doctors?

  She found Katie in X-ray. Through the small viewing window, Claire saw the girl lying on the table, her lower leg positioned beneath the X-ray tube.

  “Can I ask what the admitting diagnosis is?” Claire asked the tech.

  “They told me cellulitis of the right foot. Her chart’s over there, if you want to look at it.”

  Claire picked up the medical record and flipped to the admission note. It had been dictated by Adam DelRay at seven A.M. that morning.

  Sixteen-year-old white female who stepped on a tack two days ago. This morning she awakened with fever, chills, and swollen foot …

  Claire skimmed the history and physical, then turned the page and read the therapeutic plan.

  Quickly she picked up the phone to page Adam DelRay.

  A moment later, he walked into X-ray, looking crisply starched as usual in his long white coat. Though he had always been cordial toward her, he had never displayed any real warmth, and she suspected that under his Yankee reserve burned a masculine sense of competition, perhaps even resentment, that Claire had lured away two of his patients.

  Now he had laid claim to one of hers, and she had to suppress her own feelings of competitiveness. Only the well-being of Katie Youmans should concern her now.

  “I’ve been following Katie as an outpatient,” she said. “I know her pretty well, and—”

  “Claire, it’s just one of those things.” He lay a reassuring hand on her shoulder. “I hope you don’t take it personally.”

  “That’s not why I paged you.”

  “It was just more convenient for me to admit her. I was in the ER when she came in. And her guardian felt Katie needed an internist.”

  “I’m perfectly capable of treating cellulitis, Adam.”

  “What if it turns into osteomyelitis? It could get complicated.”

  “Are you saying a family physician isn’t qualified to take care of this patient?”

  “The girl’s guardian made the decision. I just happened to be available.”

  By now Claire was too angry to respond. Turning, she stared through the window at her patient. At her ex-patient. Suddenly she focused on the girl’s IV, and she noticed the handwritten label affixed to the bag of dextrose and water. “Is she already getting antibiotics?”

  “They just hung it,” said the X-ray tech.

  “But she’s allergic to penicillin! That’s why I paged you, Adam!”

  “The girl never said anything about allergies.”

  Claire ran into the next room, snagged the IV line, and closed off the infusion. Glancing down at Katie, she was alarmed to see the girl’s face was flushed. “I need epinephrine!” Claire called out to the X-ray tech. “And IV Benadryl!”

  Katie was moving restlessly on the table. “I feel funny, Dr. Elliot,” she murmured. “I’m so hot.” Wheals had swollen on her neck in bright blotches of red.

  The tech took one look at the girl, muttered “Oh, shit,” and yanked open the drawer for the anaphylaxis kit.

  “She didn’t tell me she was allergic,” said DelRay, defensively.

  “Here’s the epi,” said the tech, handing Claire the syringe.

  “I can’t breathe!”

  “It’s okay, Katie,” soothed Claire, uncapping the needle. “You’ll feel better in just a few seconds …” She pierced the girl’s skin and injected a tenth of a cc of epinephrine.

  “I—can’t—breathe!”

  “Benadryl, twenty-five milligrams IV!” Claire snapped. “Adam, give her the Benadryl!”

  DelRay stared down with stunned eyes at the syringe the X-ray tech had just slapped in his hand. In a daze, he injected the drug into the line.

  Claire whipped out her stethoscope. Listening to the girl’s lungs, she heard tight wheezes on both sides. “What’s the blood pressure?” she asked the tech.

  “I’m getting eighty over fifty. Pulse one-forty.”

  “Let’s move her to ER, STAT.”

  Three pairs of hands reached out to slide the girl onto the gurney.

  “Can’t breathe—can’t breathe—”

  “Jesus, she’s really swelling up!”

  “Just keep moving!” said Claire.

  Together they propelled the gurney out of X-ray and ran it down the hallway. They careened around the corner and banged through double doors into the ER. Dr. McNally and two nurses looked up, startled, as Claire announced:

  “She’s going into anaphylactic shock!”

  The response was immediate. The ER staff swung the gurney into a treatment room. An oxygen mask was pressed to the girl’s face and EKG leads clapped to her chest. Within minutes a hefty dose of cortisone was dripping into her IV.

  Her own heart was still pounding when Claire finally left the room to let McNally and his staff take over. She saw Adam DelRay standing at the nurses’ desk, furiously scribbling in Katie’s hospital record. As she approached, he quickly shut the chart.

  “She never told me she was allergic,” he said.

  “The girl is borderline retarded.”

  “Then she should be wearing a MedAlert bracelet. Why isn’t she?”

  “She refuses to.”

  “Well, I can’t guess these things!”

  “Adam, all you had to do was call me when she came in. You knew she was my patient, and that I’m familiar with her history. All you had to do was ask.”

  “The guardian should have told me. I can’t believe i
t never even occurred to that woman to—”

  He was interrupted by the loud squeal of the ER radio. They both looked up as the transmission came crackling through.

  “Knox Hospital, this is unit seventeen, unit seventeen. We have gunshot victim en route, ETA five minutes. Do you copy?”

  One of the nurses darted out of the treatment room and snatched up the microphone. “This is Knox ER. What’s that about a gunshot wound?”

  “Multiple victims en route. This one’s critical—more on the way.”

  “How many? Repeat, how many?”

  “Uncertain. At least three—”

  Another voice cut into the frequency. “Knox Hospital, this is unit nine. En route with gunshot wound to the shoulder. Do you copy?”

  In panic, the nurse grabbed the telephone and hit O. “Disaster code! Call a disaster code! This is not a drill!”

  Five doctors. That was all they could round up in the building during the frantic moments before the first ambulance arrived: Claire, DelRay, McNally from the ER, a general surgeon, and one terrified pediatrician. No one knew any details yet, not the location of the shooting, nor the number of victims. All they knew was that something terrible had happened, and that this tiny rural hospital was not prepared to deal with the aftermath. The ER turned into a maelstrom of noise and activity as personnel scrambled to prepare for the injured. Katie, now stabilized, was whisked out and shoved into the hallway to free up the treatment room. Cabinets clanged open, bright lights flared on. Claire pitched in to hang IV bags, lay out instrument trays, and rip open packets of gauze and sutures.

  The approaching wail of the first ambulance brought a split second’s hush to the ER. Then everyone surged out the double doors to meet the first victim. Standing among that crowd of personnel, Claire heard no one speak; they were all focused on the swelling scream of the siren as it drew near.

  Abruptly the siren was cut off and the flashing red light swerved into view.

  Claire pushed forward as the ambulance backed up to the entrance. The vehicle’s rear door swung open, and the stretcher rolled out with the first victim. It was a woman, already intubated. The surgical tape used to secure the ET tube obscured the lower half of her face. The bandage on her abdomen was soaked with blood.