Tuesday, July 9th Dr. Elizabeth Reed walked into the department of medical records. For privacy reasons, non-active files could not be accessed via computer. "Hello, may I see these files, please?" Naomi Sanchez took the list from her. "There are quite a few listed. Why do you need them?" Digging her shoe into the linoleum floor, her expression matched a little girl caught playing with her mom's makeup. "Shh, don't tell anybody; I forgot to include my admission summary in a few charts. The bigwigs mailed me an admonition. I want to make sure I didn't miss any more." The real reason for her review she kept private. The cases pertained to transports from the Silverton Jail. She suspected abuse by the jailers. "Okay. The third office on the left is empty." Papers in hand, Elizabeth closed and secured the door behind her. A shiver ran through her body as she read each operative report. Pictures showed similar patterns of hemorrhage. After photographing several pages, she composed herself and returned the folders with a wave. "Thank you. Have a nice day." *** Martin "Farmer" Bailey spent his morning weeding the flower beds of the Falls Church, Virginia, foreclosure he bought on Lake Barcroft. The six-bedroom lakefront home was a haven from his job as Chief Executive Officer for the restructured Chase Security International. The shower sprayed away a layer of dirt and perspiration. Humming, he remembered working on his family farm as a kid. Thoughts turned to a cherished woman from his youth—Elizabeth. As he was toweling off, Mercutio, his clownish coon cat, meowed, his magical yellow eyes glowing. "What? Are you thinking of Queen Mab?" Then he quoted from Romeo and Juliet, "She gallops night by night through lovers' brains, and then they dream of love." With a sigh, he put the past where it deserved to be and proceeded to the office. *** The words on the phone prompted disbelief. Grabbing her lab coat, Elizabeth ran for the pediatric emergency room. Calling an adult practitioner for a child was rare. "Lou, what's coming in?" Louella Miranda, the ER attending, acknowledged her and the approaching contingent. "Where's Kat Archer?" Elizabeth inquired about the hospital’s pediatric trauma surgeon. "In the OR. The cops are coming in on their own with a little kid found on the side of the road. Severe injuries are all the dispatcher said.” “For those of you who haven't met me, my name is Beth Reed. If you cannot perform the job I ask from you, speak up." Silverton Police Lieutenant Shaun Murray came running through the doors with the small victim wrapped in a blue wool cloak. Shaun, ashen and sweating, placed the child atop the stretcher. "Help..." Assessing eyes focused on the task and never took notice of the cop about to become ill as his gaze darted between the table and her. "A farmer repairing an irrigation canal. My God....never in my life... How could someone do this?" "Beth, got this?" Dr. Miranda guided the lieutenant from the room. "Let's go. Which OR?" Inside the green tiled room, two fellows, the group's senior members, looked at her with shocked eyes floating above their masks. The intonation of her voice snapped them to attention. "One bleed at a time. Life, limb, eyesight." The war zone mantra she mastered volunteering with the UN in Gaza served her well. The youngster on her table was almost ripped in two with the left leg crushed beyond repair. Unable to tell the sex of the child; it was necessary to extend the abdominal incision. "Focus, our job is to save...save this little girl." Removing the little girl's limb was the least complicated part. The staff applied the wealth of their anatomy knowledge, and Beth used all her skills. Four painstaking hours later, she thanked everyone for their hard work. By the conclusion, she learned everyone's name. "Dr. Ryan, please check in with Dr. Archer. Keep a close eye on our Jane Doe." "Dr. Reed, is she gonna make it?" the young fellow asked. "There’s a possibility. Now, a combination of luck, skill and hope, with a solid need for God's help takes over." Shaun Murray was pacing the corridor when Elizabeth left the OR. "Dr. Reed?" "Lieutenant." "Um, I brought in the child. Did...?" His voice wavered. "The little girl survived the procedure." Elizabeth kept walking. "Did you find anything to identify her?" Eyes heavy with grief greeted hers. "Sorry, I wish. Maybe if she wakes up." She picked up her pace. A hand on her shoulder slowed her down. "How can you be so cold? You saw what happened to her." A purple clog squeaked as she turned. "Of course, I spent the last four hours putting her back together. Lieutenant, would you ask that question of a male surgeon? Now, if you’ll excuse me." With her office in sight, she hurried to it before unlocking the door and pressing her back against it. As she slid to the floor, tears started to fall. The image of the little girl she operated on played over in her head. A screaming alert gave her little time to work through her emotions. *** Late Morning, Tuesday, July 9th "Time of death: 11:42. Thank you, everyone." The students stood in the resuscitation room saddened by losing the nineteen-year-old man. "Dr. Perry, come with me. Time to tell the family," Elizabeth said. "I’m not sure how to do this." Dr. Keith Perry, an intern, appeared frightened. "Time to learn. Stand by this time. Grief takes many forms, so be prepared for anything. What happened to their family member must be conveyed with respect, using understandable terms. Do not use euphemisms. Be sympathetic, share a tear. Never pretend to feel something you don't. Stop being a doctor the second you lose the anxious feelings rumbling in your gut. Stay with me, Dr. Perry. Everyone else, we will assemble in the conference room for a post mortem." The two fellows pursuing surgical critical care curricula, six other residents in the surgery education path, two additional interns and four students filed out. *** Dr. Randall Knox sat eating a sandwich and reading a cigar aficionado magazine at the conference room table with his feet propped up. Chuckling, he perused the fourteen sad faces walking in. "What, Wonder Doc kill another one?" "Dr. Knox, I think we did everything conceivable," Dr. Connor Caine, a senior fellow said. "You think, Dr. Caine? As an attending physician here for ten years, let me teach you something. Wonder Doc shows up here eighteen months ago from Hopkins, and the earth revolves around her. The scalpel she wields isn't a golden lasso of obedience, compelling a person to live. Not everyone is salvageable." *** A group of people sat huddled in the corner of the waiting room. "Excuse me, I'm looking for Arthur Maxwell's family." A man appearing to be in his forties stood. "I'm Ruben Maxwell, Arthur's father." "Mr. Maxwell, " she said, then introduced herself and her intern. "We are sorry to tell you, but despite extraordinary measures, his injuries were too grave. Arthur died.” One woman wailed. Ruben pulled another woman into his embrace. "This is my wife, Leslie. Tell us what happened to our boy." Keith witnessed Elizabeth sit with the family while she explained everything attempted. "Arthur didn't respond. Please accept our condolences." "May I see my baby?” his mother spoke in a hushed voice. "Yes, of course. Follow us.” A sheet concealed everything but Arthur’s head. A social worker and the chaplain, Reverend Harold Brookfield, attended to the Maxwells to offer support. Leslie Maxwell turned to her. "Thank you for trying to help my son." "Again, our deepest sympathy is with you. Here is my card, if you need to speak with me." Elizabeth leaned over her deceased patient and whispered, "Lord be with you." *** After the intern and surgeon stepped into the meeting room, Randall Knox gave her an unsettling once-over. Most colleagues would exit the room, but he sought every opportunity to irritate her and lower the opinion of her apprentices. They discussed the patient's death, with Elizabeth praising their work and pointing out ways to remedy difficulties. With patience, she encouraged and answered questions about procedures and options. "You got some practice, but it’s a waste of resources. What you did was useless. A lesson for you all: don't let pride rule you," Randy spoke without looking up. "What do you mean, Dr. Knox?" Krystal Slater, a second-year resident, knitted her brows. "A still heart is a dead heart." Knox's voice turned Elizabeth cold. "The kid died in the helicopter. Wonder Doc can't resist a glory call, poaching from the peds service too." Straining to stay composed finishing the critique, Elizabeth dismissed everyone to return to their assignments after she felt assured, they dealt with the loss—some for the first time. Aware of the “July effect,” or what the most morbid would call “the killing season”—when the majority of experienced trainees moved on, and the new residents were more prone to mistakes—she had to be diligent. What they absorbed would impact their future abilities. Early in her career, Elizabeth promised herself when the time came, she would be the teacher she wanted and sometimes never had. After the room emptied, she turned her ire on Knox. "Who the hell do you think you are? Please tell me. First, I did not poach a pediatric patient. The ER asked for my help because the child’s condition would not wait for Kat. And glory? That is plain offensive. About MY victim, Arthur Maxwell, bad enough you questioned my call, but if you doubted my reasoning to continue the efforts, it was unprofessional to ask in front of anyone, much less fresh learners. For your information, a teenager with a healthy heart warrants every benefit.” Her outrage and frustration exploded. "You've been on my case from the day I started. What gives?" His eyes remained fixed on the article he was reading. Furious, she left the room and grabbed a small protein smoothie from the cafeteria, downing it in no time. The Neonatal ICU, her place for comfort, was located on the eighth floor. The neonatal ICU cared for the region's premature or sick newborns. Dressing in an isolation gown, she entered a nursery for the addicted. Babies born to addicted mothers suffered severe effects, including seizures, twitching, fussiness, excessive crying, poor feeding, slow weight gain, breathing problems, fever, trouble sleeping and lots of yawning, diarrhea or throwing up, and stuffy noses, which could easily make them stop breathing. They all benefitted from love.  "Hiya, Beth." Colleen Rice smiled at her. "There is a new little one. Claude is in isolette 4. His mom used meth until her labor. The meds help a bit, but..." Elizabeth waved away the nurse's guilt. A tiny boy was wearing a blue hat and crying in jags. "Hey, handsome boy." When she scooped him up, his body stiffened. She opened the blanket to let his limbs move. Balancing the newborn over her arm, she sat in a rocking chair. A couple of tries and the little boy latched on to a bottle. Singing a song filled her with fond memories as she thought about the man, she never stopped loving. “Home Alone” –he sang it to her the night she had her wisdom teeth extracted. The medication made her scared and upset her stomach. Unlike her parents, who left her to attend a function, he refused to go. A warm remembrance of a baritone voice merged with her version. Nothing to worry your head about today, You are always safe in my embrace. As I gaze into your beautiful face, My heart fills with my love for you. We have a lifetime of things to do, But all you need is to rest without dismay. The infant settled down, and, once he fell asleep, found some peace. Dr. Lois Massey, an obstetrician, joined her friend. "Adorable, isn't he?" "Yes. What's his story?" "Mom is a long-time meth user. Urine and blood are positive. After detox, he’s going to her mother in Nebraska. Thankfully, Mom signed over her parental rights. Not great, but better than most.” The two women pondered Claude. "Bad morning, huh?" "You could say that." Before saying more, her pager vibrated. Elizabeth returned the baby to his isolette. "Gotta go." *** The intensive care unit was busy. A duo of corrections officers guarded one of the rooms. "What's going on?" Miles Gerba, the intensivist on duty, stood to answer her. "There’s an issue concerning one of Randy Knox's patients, a Silverton jail admission. Came in last night after a dispute. Dr. Simms did a liver embolization, but I don't think it worked. I paged Randy, who thinks he's malingering. Ordered Hailey Ullman to evaluate him, and per Randy, she cleared him. His BP is holding, but the man is pale, sweaty and shields from any touch," Miles reported worriedly. "Order another CT. I'll evaluate the patient and deal with Knox. Don't ever worry about calling me." "Thanks. Beth. These bruises happened over time. The man can't go back to the same cell—he will end up back here or worse." "The warden decides placement; we can only ask." The lead physicians, accompanied by two third-year residents, Byron Hall, the wide-eyed Hailey Ullman and the intensivist, walked to the prisoner’s room. Two State of Iowa corrections officers from Strongford Penitentiary stood in front of the door. "Good morning." The taller CO held the door for her. "Miles, thought you said Silverton?" "The prisoner is in our custody now. After his conviction, he was due to be transferred to us. We took over this morning," the polite second guard said. "Thank you." Elizabeth stepped between the CO's. The patient demonstrated a gray pallor and a sweat-covered forehead. "Sir, I'm Dr. Reed. Not feeling so well, hmm? Can you tell me when this started?" She washed her hands, and when she snapped her gloves on, it made him jump. "Never stopped, not since I got here," he said. "I'm so nauseous." "Did you tell anyone?" She gestured Tommy Kline, head nurse, inside. Tommy frowned. “I called Dr. Knox for an order." "Give our patient 8.0 mg ondansetron IV for nausea." With no regard for the ordering hierarchy, she took responsibility. "Please, may I examine you?" His abdomen displayed the same bruising she saw on other Silverton inmates. "How did this happen? Who hurt you?" "My bunkmate," he replied in a flat tone. "Did you strike your head?" She palpated his head and neck. "No." Elizabeth chewed her cheek. The convict had one round bruise on his back and two on his belly. Holding his hands in her now ungloved palms, she spoke to him, "I believe you are bleeding into your belly. Radiology will be up to take you for a CT scan to give me a better look. After, I'll meet you in the operating room. Dr. Hall is going to get you ready. Dr. Ullman, please notify Dr. Knox. If it’s safe for you, I’lI make sure you receive some more pain medication. Don't be afraid." Dr. Ullman, please notify Dr. Knox.” "Dr. Knox will be mad." Hailey's lip quivered. When Elizabeth's brow arched to a near perfect vee, the two male doctors backed up. "Dr. Ullman, why did you go to medical school?" "To be a physician." The resident stared at her feet. "Explain why our patient needs more testing and another operation." After listening to Hailey's explanation, Elizabeth's volume notched up. "With someone displaying symptoms like this, do you think Dr. Knox's poor frame of mind or the patient’s life is more crucial? "Patient's life." "Good answer. Make that call, assist Dr. Hall, and get me the tests. Be ready to go in one hour. One more thing." Nurses and other doctors stopped in their tracks. "No one is to refer to any patient by category again. They are all human beings, entitled to equal caretaking. Are we clear?" Diatribe complete, she spoke with the corrections officers. "Gentlemen, our patient’s condition necessitates major surgery." The first guard nodded. "I'll notify the prison." "Do all corrections officers carry those?" She pointed to the flashlight. "Yes, ma'am." Making the correlation, she wrote her orders and rushed to her office before she started the operation. From her bottom desk drawer, she pulled a list of other suspicious wounds and the photos. Everyone had circular bruises. Confirming they were transfers from Silverton jail, she googled the number and dialed. "Infirmary, please. This is Dr. Elizabeth Reed from Horizon Hospital. An inmate came to us last night. I’m trying to find out any history you have, including how he was injured." Trudy Saperstein, clinic nurse, was silent for a long pause. "Dr. Reed, according to our records, the prisoner you received was harmed during a fight with another con. Prompt arrangements for his transport were made after he was found." "Is he having trouble with this other prisoner? Also, do you have any idea what he was hit with or how long the incident lasted?" "I don't know. The chart says nothing more than you know." Trudy's cheery tone disappeared. "Give me your number, and I’ll ask the clinic physician to call you." "Thank you." Elizabeth's phone chimed. The OR and her patient were ready. *** Sergeant Austin Bailey walked the bank of the drainage ditch looking for clues about the identity and circumstances of the young child. An orange scrap of cloth—a piece of a prisoner’s uniform, caught his eye. He bagged it. "Shit." Another ten feet down the road, inside the trench, a naked, beaten man lay unmoving. He jumped down to assess whether he was alive or dead. At Austin's contact, the man groaned. "This is Bailey. I need an ambulance for a wounded man right away; location is down the Jackson culvert." He shook the injured man’s shoulder, trying to wake him. "What's your name?" "Ha...nk." "Help is coming, Hank. Who did this to you?" "Guar...ds...," he said before losing consciousness. Austin swallowed back bile as he examined the man in an attempt to render first aid. Hank's ankles and wrists presented with handcuff marks, and there was evidence of a vicious sexual assault. A Be On the Lookout warning about three escaped prisoners was issued earlier that morning. He keyed up again. "What are the names of the three escapees?" "Checking, Sergeant... Otis Frable, Ervin Pitts and Hank Price," a voice responded. "ETA on the ambulance is five minutes." "Thank you." Guards? Waiting with the man, he phoned his friend and colleague Shaun Murray. After it went to voicemail, he called his brother, Martin. "Bro, give me a buzz tonight. Need to talk to you about something." He cued his radio. "Dispatch...." A cloud of dirt moved fast toward him.