helmet. “Got it.” A pause. “Don’t let it rock.”
If it rolled forward even an inch, it might also snap both their necks.
“We won’t.”
At least Dr. Granite Jaw had a plan for this. All she had was grime from the street, a lurking wave of panic and glass shards sticking to her scrubs.
With the three of them pushing the SUV, they managed to roll it smoothly back. Pressure was released from the helmet. She eased her hands loose and when his head held position she flipped the visor open.
Finally. Another face to quiet guilty echoes in her mind.
Young. Very young. Closed eyes. Fast breathing. Still no response.
Had that been how she’d looked? Blood loss sped up respiration and heart rate as tissues and organs became deprived of oxygen, so it stood to reason that it was. Except she’d been pinned inside a vehicle, and the blood loss had been mostly visible, not hidden inside the chest cavity.
As the SUV continued to roll, revealing the man’s body, she reached for her bag again and her kit.
DellaToro joined her, unzipping the man’s protective leather jacket. At least he’d had the protection of sturdy clothing.
“His breathing is labored,” DellaToro announced.
Of course it was. She’d take comfort in him still breathing if she didn’t know how quickly that could change, and give them all a really bad day. One heartbeat to the next, things could turn, and the person you thought was most stable…
Focus.
“I’ve got some…”
She stretched to where she’d dropped her backpack and then tore into it. “Here, Dr. DellaToro.” She produced a stethoscope and handed it to him.
“Thank you, Kimberlyn. Heard you were coming.” He used her first name while taking the instrument.
Was that some kind of dominance display?
Not the time. Correct later.
She dug into the engraved silver kit again. The fact that she could act now steadied her. Those images of her wreck were still there, always there, even a thousand miles away—but now they lurked on the periphery. The rabbit hole she never wanted time to go down.
Just a little longer.
She extracted the gauze scissors and began cutting down the front of her patient’s T-shirt, exposing an already forming bruise. Deep purple stippling slashed across pale flesh, right over the sternum. Bad bruise forming. No way would it be unbroken, and a broken sternum didn’t protect what was inside very well. Bruising organs at least. Heart. Lungs, maybe. Bashing damage could be more destructive than bullets.
She bent forward to listen to her patient’s breathing as Enzo listened to his heart.
Enzo. She could do it, too.
“Steady, but fast and faint…” he announced, pulling the stethoscope from his ears to hang from his neck, and bending to grab for the penlight she’d been using under the car.
“Faint?” She repeated the word—as if she didn’t already expect that exactly to be the case. As if it could be anything else.
Her fingers searched his wrist, and she could barely feel anything but her own thundering pulse. “You’re sure it’s beating?” She fumbled beneath the edge of the helmet to find the carotid, looking for a stronger throb. Her fingers tracked over corded vessels. The jugulars stood out as if he was straining.
Distended veins in the neck. Symptom number two that she’d both expected and dreaded.
The carotid didn’t stand out at all and she felt nothing pulsing in the general region. Blood backing up in the veins and not pumping through the arteries—reason for the distended veins.
“Pupils responsive,” Enzo announced, then listened again. “Faint, but still fast. Maybe speeding up.”
She should be doing that, announcing her findings as she went. Just one more second, one more symptom… Make sure…
He hadn’t picked up on the diagnosis yet. She’d share as soon as she confirmed the third. Even if she was already certain what her fingers and eyes told her, she needed something solid to reference.
Her hand shot into her backpack again, but books and sundries blocked her search. She upended it and dumped the contents onto the pavement. The wrist BP cuff she still carried with her rolled free—her second guilty security blanket. She grabbed it and wrapped it around the man’s wrist.
“You carry a cuff?” Enzo asked, but he was listening to her as he went back to the abdomen and began prodding gently, looking for injury.
Kimberlyn didn’t answer, just pressed the button to start the automated machine and leaned forward to listen to his breathing again. “We need an ambulance. Did anyone call an ambulance?”
A beep announced the measuring of vitals had finished and she looked at the small display.
Pulse one twenty-nine. Pressure ninety-five over seventy-five.
“Crap. Crap, crap…”
Enzo’s eyes snapped to her and then to the display on the little cuff. “That’s not good.”
“No,” she said, looking around again. “Did anyone call 911?” Repeated it louder.
No one answered. The ones who’d helped push the car had already abandoned them. Enzo fished his phone from his pocket and dialed.
“We need a large syringe, and I don’t have one of those in my bag.”
Either he wasn’t worried by the situation or he didn’t realize the extent of what was going on.
“Enzo, listen to me.” She used his first name this time to capture his attention. When his eyes met hers, she had to force the words through her clenched throat. “Cardiac tamponade.”
Attention captured. “How do you know?”
“See the veins in his neck? Fluid’s coming on fast, filling his chest, and there’s no time for the pericardium to stretch and accommodate it to let his heart beat right. Either blood or serum. Probably both. Preferably more serum than blood.” More blood would probably mean a tear, but serum could just be trauma.
A cold pit opened in Enzo’s middle. They were close to the hospital, but that was the kind of diagnosis you wanted to say after remedying it.
He barked their location into the phone and followed it with, “Possible cardiac tamponade.” After demanding two additional crews and the NYPD, he ended the call and stashed his phone again. The borrowed stethoscope replaced the phone at his ear and he listened hard. The faintness bothered him. “You think pericardial effusion from the impact?”
She nodded, and from the lack of color in her face he believed her. No one could go pale for show like that.
He hadn’t had a cardiac tamponade patient in his four years of residency, but she sounded certain and had the look of someone with first-hand knowledge.
Something had to be blocking the sound of the heart. If anything, the man was underweight, nothing else made sense besides a wall of fluid muffling the sounds.
Sam Napier, his best friend in the residency program, had warned him that one of the many women in Sam’s House of Gorgeous Roommates had a cousin transferring in to chase Enzo’s fellowship. He’d expected… well, someone sunnier in disposition and appearance. A duplicate of Caren’s golden-blond curls, dimpled cheeks and the too-cheerful smiles that made it hard for him to be around her before at least two cups of coffee. Not this soft-spoken, dark-haired creature with the delicate features and soulful brown eyes.
“He was hit chest first,” she said, taking the blood pressure again. “As in he landed