Germ

The attendant pushed passed her. She stumbled backward, watched the gurney glide into Trauma Room 2. Then the door closed and she was standing in the corridor, numb and coated from waist to nose in Goody's blood.

thirteen

The bodily damage was as devastating as any Allen Parker had ever seen. Instantly, nothing else mattered: the room, the equipment, the trauma staff, his own physicality all fell away, sacrificed to the intense focus with which he attended to the patient's injuries. Everything around him paled as blood became more vivid, wounds more apparent, the needs of life more demanding. Information about the patient—called out by the staff or communicated as tones, bleeps, lights, and graphs by various machines—fell into the periphery of his awareness, absorbed without effort or recognition, but acted upon or mentally cataloged for later consideration. This was what it was all about: this one life, here and now.

His head darted to within inches of the gaping, bubbling wounds, then reared back to evaluate the injuries from different perspectives. He leaned over the body, then stood erect and slowly walked from head to belly and back again. As he went, he sealed holes in the body with squares of gauze, taping down three sides.

"Focus that light here. Four units RBCs, right? And get an operating room ready, fast."

He guessed that the carotid artery was intact, though only a surgical exploration could tell for sure. The internal and external jugular veins appeared ripped and oozing. He stepped around an intern who was busy injecting local anesthesia, skirting another who was tying off bleeding veins and arteries.

"He's 100 percent dead in the extremities," another nurse called out. "Fingers and toes are white."

"Bring that instrument tray over to me," Parker said.

The patient breathed spontaneously, but only barely. He hissed through shattered teeth, and air seeped out in gurgling bubbles through a dozen holes. Whatever had caused this damage was efficient and as ruthless as a starving shark.

"Where're the chest tubes? Come on, people!"

A section of ribs had turned into tiny fragments, which had shredded the right lung and disintegrated the liver.

"We need another surgeon. Find someone. Now!"

Blood pooled in open cavities. Pieces of flesh hung in strands.

"Get me suction. Clean here, here, and here. We're going to need more blood. Get the blood bank down here."

Parker didn't have to examine the abdomen to know the damage he would find there. A fetid stench suggested multiple perforations in the intestines. When he looked at the intestines protruding from the abdominal wall, he realized some would have to be removed altogether.

"Make it two surgeons . . . as many as we can get!"

Blood splashed and dripped and snaked toward the drain. Shock-induced endorphins probably—mercifully—prevented the man from feeling pain: a temporary reprieve at best, unless death snatched him from pain's grasp first.

Parker shook his head.

"If he codes, make it a DNR," he called out.

The Do Not Resuscitate order told the medical staff what they needed to know. Pulling out all stops to restore life upon cardiac arrest would most likely lead to an endless cycle of rescuing the poor soul from the brink of eternity, until he finally teetered over the edge forever. Restarting the heart could fool clinical death for only so long before the injuries caused biological death, in which all tissue dies: the end.

As a nurse blotted a section of the chest wound, Parker caught a glimpse of something too symmetrical to be organic. It appeared firmly embedded in the man's sternum.

"Whoa, whoa," he said. "What's this?"

Using forceps, he clamped the small, round object and tugged on it. He had to apply more force than he'd expected, but it finally popped loose. It was a black metal disk, razor sharp.

"Yow."

He dropped it into a stainless steel bowl. "Listen up, people," he announced. "It appears somebody has turned this man into a radial saw. Nobody sticks their hands in, got it? Use instruments—forceps and clamps. I want to see survey films of this whole area. Let's find out how many of these ugly buggers we're dealing with, and where they're hiding."

Nurses rushed to the table with masking tape and started marking off the edges of the wound.

The patient sputtered, and what came out sounded like a word. Parker turned to see the man's remaining eye focused on him. The gaze was piercing, intense. Jaw muscles bulged with effort, and the patient's mouth parted slightly. He was trying to talk.

Parker leaned his ear close. Hot, vile breath washed over him, then spatters of blood. Words followed. He bent lower, until his ear was nearly touching the man's mutilated lips. Parker's eyes narrowed, then grew wide. He tried to pull away, but the man's left hand had incredibly reached over Parker's head, holding him. The patient continued to speak in stuttering gasps.