Genesis Page 3

  "It's all right," Sara answered, wondering why she'd even told the woman such a personal detail. Her life over the last few years had been dedicated to not talking about Jeffrey, and here she was sharing him with a stranger. She tried to ease the tension by adding, "You're right. He cheated on me, too." At least he had the first time Sara married him.

  "I'm so sorry," Faith repeated. "Was he on duty?"

  Sara didn't want to answer her. She felt nauseated and overwhelmed, probably a lot like Faith had felt before she'd passed out in the parking lot.

  Faith picked up on this. "You don't have to—"

  "Thanks."

  "I hope they got the bastard."

  Sara put her hand into her pocket, her fingers wrapping around the edge of the letter. That was the question everyone wanted answered: Did they get him? Did they catch the bastard who killed your husband? As if it mattered. As if the disposition of Jeffrey's killer would somehow alleviate the pain of his death.

  Mercifully, Mary came into the room. "Sorry," the nurse apologized. "The old lady's kids just dropped her here. I had to call social services." She handed Sara a piece of paper. "CMP's back."

  Sara frowned as she read the numbers on the metabolic profile. "Do you have your monitor?"

  Mary reached into her pocket and handed over her blood glucose monitor.

  Sara swabbed some alcohol on the tip of Faith's finger. The CMP was incredibly accurate, but Grady was a large hospital and it wasn't unheard of for the lab to get samples mixed up. "When was the last time you had a meal?" she asked Faith.

  "We were in court all day." Faith hissed "Shit" as the lancet pierced her finger, then continued, "Around noon, I ate part of a sticky bun Will got out of the vending machine."

  Sara tried again. "The last real meal."

  "Around eight o'clock last night."

  Sara guessed from the guilty look on Faith's face that it had probably come out of a take-away bag. "Did you have coffee this morning?"

  "Maybe half a cup. The smell was a bit too much."

  "Cream and sugar?"

  "Black. I usually eat a good breakfast—yogurt, fruit. Right after my run." Faith asked, "Is something wrong with my blood sugar?"

  "We'll see," Sara told her, squeezing some blood onto the test strip. Mary raised an eyebrow, as if to ask if Sara wanted to place a wager on the number. Sara shook her head: no bet. Mary persisted, using her fingers to indicate one-five-zero.

  "I thought the test came later," Faith said, sounding unsure of herself. "When they make you drink the sugary stuff?"

  "Have you ever had any problems with your blood sugar? Is there a history in your family?"

  "No. None."

  The monitor beeped and the number 152 flashed on the screen.

  Mary gave a low whistle, impressed by her own guess. Sara had once asked the woman why she didn't go to medical school, only to be told that nurses were the ones who practiced the real medicine.

  Sara told Faith, "You have diabetes."

  Faith's mouth worked before she managed a faint, "What?"

  "My guess is that you've been pre-diabetic for a while. Your cholesterol and triglycerides are extremely elevated. Your blood pressure is a little high. The pregnancy and the rapid weight gain—ten pounds is a lot for nine weeks—plus your bad eating habits, pushed you over the edge."

  "My first pregnancy was fine."

  "You're older now." Sara gave her some tissue to press against her finger so the bleeding would stop. "I want you to follow up with your regular doctor first thing in the morning. We need to make sure there's not something else going on here. Meanwhile, you have to keep your blood sugar under control. If you don't, passing out in the parking lot will be the least of your worries."

  "Maybe it's just—I haven't been eating right, and—"

  Sara cut her off mid-denial. "Anything over one-forty is a positive diagnosis for diabetes. Your number has actually inched up since the first blood test was taken."

  Faith took her time absorbing this. "Will it last?"

  The question was one for an endocrinologist to answer. "You'll need to talk to your doctor and have him run some more tests," Sara advised, though, if she had to make an educated guess, she would say that Faith was in a precarious situation. Except for the pregnancy, she would be presenting as a full-blown diabetic.

  Sara glanced at her watch. "I would admit you tonight for observation, but by the time we processed you and found you a room, your doctor's office would be open, and something tells me you wouldn't stay here anyway." She had spent enough time around police officers to know that Faith would bolt the minute she got the chance.

  She continued, "You have to promise me that you'll call your doctor first thing—and I mean that, first thing. We'll get a nurse educator in here to teach you how to test your blood and how and when to inject yourself, but you've got to follow up with him immediately."

  "I have to give myself shots?" Faith's voice went up in alarm.

  "Oral meds aren't approved for use in pregnant women. This is why you need to talk to your doctor. There's a lot of trial and error here. Your weight and hormone levels will change as the pregnancy progresses. Your doctor's going to be your best friend for the next eight months, at least."

  Faith seemed embarrassed. "I don't have a regular doctor."

  Sara took out her prescription pad and wrote down the name of a woman she'd interned with years ago. "Delia Wallace works out of Emory. She has a dual specialty in gynecology and endocrinology. I'll call her tonight so her office knows to work you in."

  Faith still seemed unconvinced. "How can I suddenly have this? I know I've put on weight, but I'm not fat."

  "You don't have to be fat," Sara told her. "You're older now. The baby affects your hormones, your ability to produce insulin. You haven't been eating well. The stars lined up and it triggered you."

  "It's Will's fault," Faith mumbled. "He eats like a twelve-year-old. Doughnuts, pizza, hamburgers. He can't go into a gas station without buying nachos and a hot dog."

  Sara sat down on the edge of the bed again. "Faith, this isn't the end of the world. You're in good shape. You've got great insurance. You can manage this."

  "What if I . . ." She blanched, breaking eye contact with Sara. "What if I wasn't pregnant?"

  "We're not talking about gestational diabetes here. This is full blown, type two. A termination won't suddenly make the problem go away," Sara answered. "Look, this is probably something you've been building up to for a while. Being pregnant brought it on faster. It will make things more complicated in the beginning, but not impossible."

  "I just . . ." She didn't seem capable of finishing a sentence.

  Sara patted her hand, standing. "Dr. Wallace is an excellent diagnostitician. I know for a fact that she takes the city insurance plan."

  "State," Faith corrected. "I'm with the GBI."

  Sara assumed the Georgia Bureau of Investigation's plan was similar, but she didn't quibble. Faith was obviously having difficulty absorbing the news, and Sara had not exactly eased her into it. You couldn't unring a bell, though. Sara patted her arm. "Mary will give you an injection. You'll be feeling better in no time." She started to leave. "I mean it about calling Dr. Wallace," she added firmly. "I want you on the phone with her office first thing in the morning, and you need to be eating more than sticky buns. Low-carb, low-fat, regular, healthy meals and snacks, okay?"

  Faith nodded, still dumbstruck, and Sara left the room feeling like an absolute heel. Her bedside manner had certainly deteriorated over the years, but this represented a new low. Wasn't that anonymity why she had come to Grady in the first place? But for a handful of homeless men and some prostitutes, she seldom saw a patient more than once. That had been the real pull for Sara—the absolute detachment. She wasn't at a stage in her life where she wanted to make connections with people. Every new chart was an opportunity to start all over. If Sara was lucky—and if Faith Mitchell was careful—they would probably never see each other
again.

  Instead of going back into the doctors' lounge to finish her charts, Sara walked past the nurses' station, through the double doors, into the overfilled waiting room and finally found herself outside. There were a couple of respiratory therapists by the exit smoking cigarettes, so Sara kept walking toward the back of the building. Guilt about Faith Mitchell still hung heavy on her shoulders, and she looked up Delia Wallace's number in her cell phone before she forgot to follow up. The service took her message about Faith, and Sara felt slightly better as she ended the call.

  She had run into Delia Wallace a couple of months ago, when the woman had come in to see one of her wealthy patients who had been airlifted to Grady after a bad car accident. Delia and Sara had been the only women in the top five percent of their graduating class at Emory University Medical School. At the time, it was an unwritten rule that there were two options for female doctors: gynecology or pediatrics. Delia had chosen the first, Sara the latter. They would both turn forty next year. Delia seemed to have everything. Sara felt like she had nothing.

  Most doctors—Sara included—were arrogant to one degree or another, but Delia had always been an avid self-promoter. While they drank their coffees in the doctors' lounge, Delia quickly offered the highlights of her life: a thriving practice with two offices, a stockbroker husband and three overachieving kids. She'd shown Sara pictures of them all, this perfect family of hers who looked as if they had walked out of a Ralph Lauren advertisement.

  Sara hadn't told Delia about her own life after medical school, that she had gone back to Grant County, her home, to tend to children in rural areas. She didn't tell Delia about Jeffrey or why she moved back to Atlanta or why she was working at Grady when she could open her own practice and have some semblance of a normal life. Sara had just shrugged, saying, "I ended up back here," and Delia had looked at her with both disappointment and vindication; both emotions conjured by the fact that Sara had been ahead of Delia their entire time at Emory.

  Sara tucked her hands into her pockets, pulling her thin coat closed to fight the chill. She felt the letter against the back of her hand as she walked past the loading dock. She had volunteered to cover an extra shift that morning, working straight through for nearly sixteen hours so that she could have all of tomorrow off. Exhaustion hit her just as the night air did, and she stood with her hands fisted in her pockets, relishing the relatively clean air in her lungs. She caught the scent of rain under the smell of car exhaust and whatever was coming off the Dumpster. Maybe she would sleep tonight. She always slept better when it rained.

  She looked down at the cars on the interstate. Rush hour was at its tail end—men and women going home to their families, their lives. Sara was standing at what was called the Grady Curve, an arc in the highway that traffic reporters used as a landmark when reporting trouble on the downtown connector. All the taillights were bright red tonight as a tow truck pulled a stalled SUV from the left-hand shoulder. Police cruisers blocked the scene, blue lights spinning, casting their eerie light into the darkness. They reminded her of the night Jeffrey had died—the police swarming, the state taking over, the scene combed through by dozens of men in their white suits and booties.

  "Sara?"

  She turned around. Mary stood with the door open, waving her back into the building. "Hurry!"

  Sara jogged toward the door, Mary calling out stats as she got closer. "Single car MVA with pedestrian on foot. Kraukauer took the driver and passenger, possible MI on the driver. You've got the woman who was hit by the car. Open frac on right arm and leg, L-O-C at the scene. Possible sexual assault and torture. Bystander happened to be an EMT. He did what he could, but it's bad."

  Sara was sure she'd misunderstood. "She was raped and hit by a car?"

  Mary didn't explain. Her hand was like a vise on Sara's arm as they jogged down the hallway. The door was open to the emergency triage room. Sara saw the gurney, three medics surrounding the patient. Everyone in the room was a man, including Will Trent, who was leaning over the woman, trying to question her.

  "Can you tell me your name?" he asked.

  Sara stopped short at the foot of the bed, Mary's hand still on her arm. The patient was lying curled on her side in a fetal position. Surgical tape held her tightly to the frame of the stretcher, pneumatic splints binding her right arm and leg. She was awake, her teeth chattering, murmuring unintelligibly. A folded jacket was under her head, a cervical collar keeping her neck in line. The side of her face was caked in dirt and blood; electrical tape hung from her cheek, sticking to her dark hair. Her mouth was open, lips cut and bleeding. The sheet they had covered her with was pulled down and the side of her breast gaped open in a wound so deep that bright yellow fat was showing.

  "Ma'am?" Will asked. "Are you aware of your condition?"

  "Move away," Sara ordered, pushing him back harder than she intended. He flailed, momentarily losing his balance. Sara did not care. She had seen the small digital recorder he had in his hand and did not like what he was doing.

  Sara put on a pair of gloves as she knelt down, telling the woman, "I'm Dr. Linton. You're at Grady Hospital. We're going to take care of you."

  "Help . . . help . . . help . . ." the woman chanted, her body shivering so hard the metal gurney rattled. Her eyes stared blankly ahead, unfocussed. She was painfully thin, her skin flaky and dry. "Help . . ."

  Sara stroked back her hair as gently as she could. "We've got a lot of people here and we're all going to help you. You just hang on for me, okay? You're safe now." Sara stood, lightly resting her hand on the woman's shoulder to let her know she was not alone. Two more nurses were in the room, awaiting orders. "Somebody give me the rundown."

  She had directed her request toward the uniformed emergency medical techs, but the man across from her started talking, delivering in rapid staccato the woman's vitals and the triage performed en route. He was dressed in street clothes that were covered in blood. Probably the bystander who had given aid at the scene. "Penetrating wound between eleventh and twelfth ribs. Open fractures right arm and leg. Blunt force trauma to the head. She was unconscious when we arrived, but she gained consciousness when I started working on her. We couldn't get her flat on her back," he explained, his voice filling with panic. "She kept screaming. We had to get her in the bus, so we just strapped her down. I don't know what's wrong with . . . I don't know what—"

  He gulped back a sob. His anguish was contagious. The air felt charged with adrenaline; understandably so, considering the state of the victim. Sara felt a moment of panic herself, unable to take in the damage inflicted on the body, the multiple wounds, the obvious signs of torture. More than one person in the room had tears in their eyes.

  Sara made her voice as calm as possible, trying to bring the hysteria down to a manageable level. She dismissed the EMTs and the bystander by saying, "Thank you, gentlemen. You did everything you could just to get her here. Let's clear the room now so that we have space to keep helping her." She told Mary, "Start an IV and prep a central line just in case." She told another nurse, "Get portable X-ray in here, call CT and get the surgical on-call." And said to another, "Blood gas, tox screen, CMP, CBC, and a coag panel."

  Carefully, Sara pressed the stethoscope to the woman's back, trying not to concentrate on the burn marks and crisscrossed slices in the flesh. She listened to the woman's lungs, feeling the sharp outline of ribs against her fingers. Breath sounds were equal, but not as strong as Sara would've liked, probably because of the massive amount of morphine they had given her in the ambulance. Panic often blurred the line between helping and hindering.

  Sara kneeled down again. The woman's eyes were still open, her teeth still chattering. Sara told her, "If you have any trouble breathing, let me know, and I'll help you immediately. All right? Can you do that?" There was no response, but Sara kept talking to her anyway, announcing every step of the way what she was doing and why. "I'm checking your airway to make sure you can keep breathing," she said, gently pressing in
to the jaw. The woman's teeth were reddish pink, indicating blood in her mouth, but Sara guessed that was from biting her tongue. Deep scratches marked her face, as if someone had clawed her. Sara thought she might have to intubate her, paralyze her, but this might be the last opportunity the woman had to speak.

  That was why Will Trent would not leave. He had been asking the victim about her condition in order to set up the framework for a dying declaration. The victim would have to know she was dying before her last words could be admitted in court as anything other than hearsay. Even now, Trent kept his back to the wall, listening to every word being spoken in the room, bearing witness in case he was needed to testify.

  Sara asked, "Ma'am? Can you tell me your name?" Sara paused as the woman's mouth moved, but no words came out. "Just a first name, all right? Let's start with something easy."

  "Ah . . . ah . . ."

  "Anne?"

  "Nah . . . nah . . ."

  "Anna?"

  The woman closed her eyes, gave a slight nod. Her breath had turned more shallow from the effort.

  Sara tried, "How about a last name?"

  The woman did not respond.

  "All right, Anna. That's fine. Just stay with me." Sara glanced at Will Trent. He nodded his thanks. She returned to the patient, checking her pupils, pressing her fingers into the skull to check for fractures. "You've got some blood in your ears, Anna. You took a hard knock to your head." Sara took a wet swab and brushed it across the woman's face to remove some of the dried blood. "I know you're still in there, Anna. Just hang on for me."

  With care, Sara traced her fingers down the neck and shoulder, feeling the clavicle move. She continued down gently, checking the shoulders front and back, then the vertebrae. The woman was painfully undernourished, the bones starkly outlined, her skeleton on display. There were tears in the skin, as if barbs or hooks had been imbedded under the flesh, then ripped out. Superficial cuts sliced their way up and down the body, and the long incision on the breast already smelled septic; she had been like this for days.