Chapter 1

It was still dark when the Backstreet Boys left their hotel that morning. As soon as he set foot outside, Brian Littrell wished he were back in bed. The hard hotel mattress wasn’t exactly the most comfortable thing he’d ever slept on, especially compared to his waterbed back home, but at least it had been warm under the covers. Not the case on the streets of Chicago, where it felt more like mid-winter than the last day of summer. It had rained overnight, and a thick fog had rolled in with the cold front. The fog was so dense that, looking up, Brian couldn’t even see the tops of the tall buildings. They just seemed to disappear into the clouds.

A fat raindrop fell from the awning they were huddled under and splattered in the center of Brian’s forehead. He wiped it off quickly and took a step backwards, shivering from the sudden chill. His fingers fumbled with the zipper of his jacket.

“Shit, it’s cold!” he heard AJ exclaim. “Mom better hurry the hell up with the van before I freeze my nuts off!”

“Language,” warned Lou, wagging a sausage-like finger at AJ. “You boys better start watching your mouths. None of that kind of talk at the radio station, got it? I want you to present a professional image. Be polite - please and thank you, all the way.”

“Got it,” said AJ, rolling his eyes behind Lou’s back.

Brian smiled to himself. He had never been on the receiving end of one of Lou Pearlman’s lectures about etiquette - after all, his mother had taught him to mind his manners - but at the same time, he could understand AJ’s annoyance. Lou expected them to behave as professionals, but sometimes he treated them like children. Calling them “boys” all the time, reminding them to say “please” and “thank you.” Granted, their group was called “The Backstreet Boys,” but most of its members were no longer “boys.” Howie and Kevin, the oldest, had been legal adults for several years now, and Brian would turn twenty-one in another five months. Even the youngest, Nick, was fifteen already. He was growing up - literally - before their eyes. The little blond kid Brian had met two years ago was now a lanky teenager, taller than Brian. How had that happened?

He looked over at Nick, who had his hands crammed in his pockets and was bouncing up and down on the balls of his feet. Even when he wasn’t trying to stay warm, Nick was always moving. He could play video games for hours, but even then, he couldn’t sit still - he would jerk from side to side and jump whenever his character did, as if he could control its movements with his body. It was no wonder he stayed so skinny, despite eating like a garbage disposal. He clearly burned off every calorie he consumed and somehow still seemed to have boundless energy. The only time Nick really stopped moving was when he slept - and he hadn’t slept nearly enough the night before, thought Brian, stifling a yawn. The kid had kept him up late last night, playing video games in their hotel room until after midnight. They’d only gotten a few hours’ sleep before Kevin came pounding on their door, telling them it was time to get moving.

“Why do we have to be there so early?” Nick whined, echoing Brian’s sentiments.

“It’s a morning show,” Lou answered curtly. “They’re on air at five a.m.”

“But we’re not going on ‘til seven. Why couldn’t we just leave at six-thirty?”

“It’s always good to get there early, especially for a live interview. Besides, you never know what traffic will be like in a big city like Chicago - hopefully we’ll avoid rush hour this way.” Lou turned around to smile at the rest of the group, his breath puffing out of his open mouth in large clouds. “When you’re big stars, boys, you can be fashionably late,” he said, wagging his finger again, “but until then, we’ll arrive on time. Remember, the early bird catches the worm! Ah, there’s the van now.”

AJ rolled his eyes again once Lou had turned back around. Brian caught Nick’s eye and grinned. They called Lou “Big Poppa,” but it wasn’t because of his fatherly advice. Lou was like the fairy godfather of their group, the reason Brian had been whisked away to Orlando from his home in Lexington, Kentucky to live a dream he hadn’t even realized he’d had. It had been Kevin’s dream to be a pop star, not Brian’s. His cousin had moved to Florida first to kickstart his music career, while Brian had been happy just singing in church at home in Kentucky. He would have been halfway through Bible college by now, had it not been for that fateful day, two-and-a-half years ago, when Kevin had called him out of class to invite him to an audition in Orlando. It was there that he’d met Nick Carter, AJ McLean, Howie Dorough, and Lou Pearlman, the honorary “sixth Backstreet Boy,” who had been working tirelessly to get his new vocal group off the ground.

For the past two years, the Backstreet Boys had been chasing fame. They had traveled across the country, performing at schools and malls. They’d put in hundreds of hours at rehearsal halls and recording studios, most recently in Stockholm, Sweden, where they had spent one week of the summer recording with a pair of Swedish songwriters named Max Martin and Denniz PoP. They had produced a single, “We’ve Got It Goin’ On,” which Lou was desperately trying to get on the airwaves. He had organized their current publicity tour, booking the Boys interviews on radio stations throughout the United States in an effort to promote the single. So far, the reception had been lukewarm.

Thankfully, the van was warm. Brian felt the blast of heat as soon as Kevin opened the back door. He sighed with relief. “I call the back!” he shouted, ducking under his cousin’s arm to scramble into the van first. Okay, so maybe he wasn’t all that grown up, but he couldn’t help trying to annoy Kevin. It was so easy - and so much fun.

“I’m sittin’ by Brian!” Nick echoed, barreling past Kevin to get in the back seat with Brian. He was like an overgrown puppy who didn’t realize how big he had gotten. He tripped over his own feet in the aisle and fell, rather than sat, face first into the seat.

“Have a nice trip, Frack?” Brian couldn’t help but say with a grin.

Nick flopped over, pushing his hair out of his face as he settled back into his seat. “Yeah, yeah, I know what comes next,” he said, grinning back good-naturedly. “‘See ya next fall!’ Ain’t that right, Frick?”

“Guess I need to learn some new jokes, huh?”

“No duh!”

Brian smiled to himself as he fastened his seat belt. Frick and Frack. They were five years apart, but closer than anyone in the group. Brian supposed the fact that he was best friends with a fifteen-year-old didn’t speak much for his maturity, but it was more than just a friendship. Nick Carter was like the little brother Brian had never had, and since Nick was the oldest of five, Brian was not only a best friend, but a big brother. He loved the way Nick looked up to him.

“Seatbelt, Nick,” reminded Kevin, turning around in the seat in front of him. “You too, AJ.”

AJ had wedged himself into the back seat between Brian and Nick, while Howie took the middle seat next to Kevin. Lou rode up front in the passenger seat, so he could navigate while AJ’s mother, Denise, drove. “It’s on North Stetson,” Brian heard him say, as the van pulled away from the curb. “Just on the other side of the river.”

“I still didn’t hear your seatbelt click, Nick,” said Kevin in a sing-song voice, sounding just like someone’s father.

“All right, Dad!” Nick retorted, rolling his eyes as he grudgingly pulled the belt across his lap. “I hate these things,” he muttered.

Brian smiled. “He just doesn’t want you bouncing all over the place.”

“Yeah, well, I can still do this.” Nick kicked the back of Kevin’s seat, hard.

“Knock it off back there,” Kevin warned, sounding even more like a disgruntled dad. He didn’t seem to realize he was only encouraging them.

Brian couldn’t resist. “Are we there yet?” he asked in an obnoxious whine.

Kevin’s head whipped around, his thick eyebrows furrowing as he frowned. “Seriously? It’s too early to start this. Please stop.”

“You stop,” said Nick.

“Boys,” reprimanded Big Poppa from the front seat. Kevin sighed and turned back around.

With Nick sulking in the back seat, they settled into a sleepy silence as the van crawled through the city streets. Brian looked out his window, watching the sights through a film of drizzle and fog.

“Why don’t you get on Lake Shore?” he heard Lou telling Denise. AJ’s mother had been heavily involved in the Backstreet Boys’ business since the beginning, but lately, she had become more like a manager than the couple Lou had hired to be their real managers, Johnny and Donna Wright. The Wrights, who had also managed New Kids on the Block, had stayed behind to work with Lou’s other boyband, another quintet of Florida boys who called themselves *NSYNC.

The other boyband had become a point of contention between the Backstreet Boys and their managers. Brian thought at least one of the Wrights should have come along on their radio tour, but he supposed having Lou and Denise there was just as good, if not better. He knew his mom appreciated knowing that another mother was traveling with them. It didn’t matter that he was twenty and too old for a chaperone; she still worried. Jackie Littrell would always worry about her “Baby Duck.” It worked out well for Nick’s mom, too. He and AJ were both still minors, but while AJ was an only child, Nick had four younger siblings at home. With Denise McLean on the road to baby-sit “the boys,” Jane Carter could stay home to take care of her other children. Nick seemed to appreciate this arrangement as well. Brian knew it made him feel more grown up to be on tour without his mother around.

The van’s brakes squealed against the wet pavement as Denise stopped at a red light. “Sorry!” she called back. “The fog’s really bad. I can hardly see ten feet in front of me!”

“That’s all right. Take your time,” said Kevin in his slow, mellow drawl. The light changed to green, and the van turned right. “Look out your window, Nick - there’s Lake Michigan.”

Kevin always liked to play tour guide and point out interesting sights to the younger group members. Normally, Nick loved anything to do with water, but he was in a cranky mood that morning. Yawning with boredom, he replied, “I can’t see nothin’.”

“Can’t see anything,” Kevin corrected.

“Exactly. The fog’s too thick. I can’t tell where the sky ends and the water starts.”

“It’s like the edge of the world,” said Brian, peering out Nick’s window into the endless gray haze.

This comment seemed to fascinate Nick. “Yeah… we could drive off a cliff and never know it!” he exclaimed, pressing his nose against the glass.

“Dude, don’t say shit like that,” said AJ from the middle seat, shuddering.

“Language,” warned Lou and Denise in perfect unison from the front.

“Sorry.”

Brian was still looking out Nick’s window when he heard Lou shout, “Denise!” He turned his head and saw the red glow of brake lights emerging out of the fog, heard the tires squeal against the pavement once again, and felt the van swerve sharply to the right. He never saw what they hit, but he heard the chorus of screams and the crunch of metal and glass and felt the impact only briefly before his head bashed into something hard. Then, with the sound of screams still ringing in his ears, the gray fog seemed to surround him. It swallowed him up, and down, down, he descended into total darkness.

***

Chapter 2

The sky was just starting to lighten when the call came through, though the fog had yet to lift. Looking out the window of the ambulance, Carol Hathaway could hardly tell where in the city they were. Shep seemed to have no problem navigating the streets of Chicago, though. He drove one-handed as he reached for the radio.

“This is Unit Forty-Seven, Dispatch, go ahead.”

“Forty-Seven, please respond to the scene of a single-vehicle accident in the southbound lane of the upper deck of the bridge on Lake Shore Drive,” the EMS dispatcher’s voice crackled through the receiver. “Multiple injuries have been reported.”

“On our way,” said Shep, setting down the radio. Then he looked at Carol. “Mind if we make a quick pit stop, Nurse Hathaway?”

Carol laughed. “Like I have a choice?”

Shep grinned. “Buckle up, baby; we’re goin’ for a ride.” With the flip of a switch, he turned on the lights and sirens. “Admit it,” he added, over the wail. “You like a little excitement on the way to work. Otherwise you’d’ve taken the train.”

“This is cheaper,” said Carol. Faster, too, she thought, holding her breath as he laid on the horn and sailed through a stoplight. She would never admit it to paramedic Ray Shepard, who was as cocky as he was charismatic, but she did like the excitement of his job. It made her feel alive.

That was a far cry from how she had felt last fall - like she was dead inside, like she wanted to be dead on the outside, too - but Shep didn’t know anything about her failed suicide attempt. He didn’t need to know, not yet. After all, she had only known him a few weeks. They hadn’t even slept together, though not for a lack of trying on Shep’s part. He had been pursuing her ever since she’d completed a paramedic ride-along with him and his partner, Raul Melendez, for her recertification as a registered emergency room nurse. At first, she had tried to turn down his advances - after all, it had only been four months since she’d split with her former fiancée - but Shep was persistent. He had wooed her with Ferris wheel rides and dinner dates and unnecessary radio checks in the ER. Now he was giving her rides to work in his rig. She could only imagine how Raul must razz him when she wasn’t around, but thankfully for Shep, his partner mostly kept his mouth shut in her presence. He rode in the back, occasionally poking his head between the seats to check on their progress.

“Where the hell are we?” Raul asked at one point.

“Almost to Lake Shore,” Shep replied.

“How can you tell? You can’t even see the street signs.”

Shep pointed out the windshield. “You see any buildings up ahead?”

“Man, I can’t see anything through this shit.”

“Well, look. There’s the lake.”

Carol peered out Shep’s window as he made a right turn onto Lake Shore Drive. Lake Michigan was hardly discernible through the gray fog. It wouldn’t be the last motor vehicle accident they saw that day, if this didn’t let up. She could only imagine what a nightmare rush hour was going to be. Traffic was already starting to pick up.

As they approached the double-decker bridge, she could see red and blue lights flashing through the fog. A police car was parked at an angle across the two outer lanes, blocking traffic. Just beyond it, Carol could see a large, silver van smashed against the guardrail on the side of the road. The momentum of the crash had carried it halfway up the cement barrier - a little more speed, and it might have flipped right over. Its right front tire was hanging over the edge of the embankment, as if someone had propped it there. “Looks like it could have been a lot worse,” she remarked, pointing this out to Shep. It was a long drop from the upper deck to the river below.

Shep pulled the ambulance around the scene of the accident and parked it in front. Before he and Carol could even climb out of the cab, Raul had the back doors open and was starting to unload equipment. Shep hoisted his medical bag into Carol’s hands and hurried to help his partner, while she ran ahead to start triaging victims. One of the police officers was talking to a woman who looked shaken and distraught, but otherwise unhurt. “The car in front of me must have stopped; I couldn’t see it until it was too late!” Carol heard her saying, her voice shrill and tremulous. “I guess I swerved. I don’t even remember; it all happened so fast…”

The other officer had managed to slide open the rear side door. “Hi, I’m Carol Hathaway; I’m an R.N. at County,” said Carol as she came up behind him, looking in over his shoulder. She quickly counted five people in the back and one front seat passenger.

“Glad you’re here,” said the cop, turning to talk to her. “Listen, the driver seems fine, but I’m not too sure about these guys.” He moved aside to let Carol in for a closer look. She was glad to see that many of the passengers were conscious. They were mostly young men - late teens or early twenties, she estimated. The blond boy in the back looked especially young.

“Hi, I’m Carol,” she called into the van. “Don’t worry; we’re going to get you out of here just as soon as we can. I just need to check and see how badly you’re injured. Sit tight, and try not to move.”

“Please, help Brian first,” begged the man in the left middle seat. Gritting his teeth in pain, he pointed to one of the boys in the back, who was slumped against the window with his eyes closed. “He’s my cousin. I think he’s hurt bad; he hasn’t come to yet.”

Carol climbed into the van, stepping carefully over the passengers who were conscious to get to the one who wasn’t. She slipped a stethoscope into her ears and pressed the diaphragm to the boy’s chest, listening for heart and breath sounds. “What’s wrong with Brian?” she heard the young blond boy ask. “Is it bad?” Carol held up a finger, signaling for him to be quiet. She hoped her face hadn’t betrayed her. She tried to keep it blank as she listened to the victim’s chest, but what she heard was cause for concern. Although the boy was breathing, she had detected an obvious heart murmur, which could mean a serious injury. She knew it was one of the symptoms of an aortic dissection, and that if the largest artery in his body ruptured, he’d be dead in a matter of minutes.

Backing out of the van, she pulled Shep aside. “The boy in the back may have a tear in his aorta,” she told him in a low voice. “We need to get him out and transported ASAP.”

Shep surveyed the situation inside the van. “There’s no way we’re getting him out of there safely without extricating the others first.”

“Then let’s get these guys out as quickly as we can.”

With Raul’s help, they set about assessing the others’ injuries, starting with the boy sitting closest to the door. The right side of his face was a bloody mess from striking something, most likely the window. “What’s your name?” Carol asked him, looking into his big, brown eyes. One of them was already starting to swell shut, making it hard to tell if his pupils were the same size.

“Howie,” the boy replied shakily.

“Can you tell me what hurts, Howie? Any neck, back, or abdominal pain?”

“My head and neck, a little,” mumbled Howie, reaching up to rub the side of his neck. At least he could move his hand, Carol observed; that was a good sign. Still, his facial trauma suggested a possible brain or spinal cord injury, so they couldn’t be too careful.

“We’re going to put a collar around your neck to stabilize it while we get you out of here,” she told Howie. “Hold still. Shep, let’s get a C-collar on him.” Carol put her hands on both sides of Howie’s neck to hold it steady while Shep strapped on the cervical collar. Then she stepped aside while Shep and Raul worked together to unbuckle Howie from his seat and expertly slide him onto a backboard. This was another necessary precaution to protect his spine, but as she watched the two paramedics strap Howie to the board, a troubling thought occurred to her. “Make sure you monitor his breathing,” she told them in a low voice. “If there’s too much blood or swelling, his airway may be compromised.”

“Thanks for the tip, Nurse Hathaway,” said Shep, shooting her an impish grin. “How ya doin’, Howie, any trouble breathing?”

“No,” Howie replied uncertainly. His one open eye kept darting back and forth; he looked terrified.

“All right, let’s get him to the rig and check his pulse ox. We can suction him there and start him on oxygen if we need to,” Shep told Raul. “If he goes south, we’ll intubate.”

As they wheeled Howie off to the ambulance on a stretcher, Carol climbed back into the van to check the next passenger, the one who had told her to help his cousin first. “What’s your name?” she asked him.

“Kevin, but, please, help them first,” he insisted, jerking his thumb over his shoulder to indicate the three boys in the back. “I’m all right; it’s just my leg.”

He had an open fracture of the lower right leg; Carol could see his tibia poking through the torn and bloodied skin of his shin. An injury like that needed to be treated quickly in order to prevent infection or loss of circulation and salvage the limb. “You have a pretty serious injury, Kevin,” she told him. “We need to get you out of here first, and then we'll be able to get to the others. Are they your friends? Brothers?”

“Not by blood, but they may as well be my brothers,” Kevin muttered, closing his eyes as she checked his vitals. “We’re a singing group; we’ve been together for almost three years.”

“Oh yeah?” Carol raised her eyebrows. “Should I know who you are?”

He tried to smile, but he was in so much pain that it looked more like a grimace. “Not yet, but someday… someday, you will. We’re called the Backstreet Boys. Remember that name.”

“Backstreet Boys,” Carol repeated, as she inflated the blood pressure cuff around his upper arm. “Got it.” She slipped the stethoscope into her ears and pressed the diaphragm to the inside of his elbow, then slowly released the pressure in the cuff. As she strained to listen for the sound of blood flowing through his brachial artery, she could hear sirens approaching in the background.

By the time she and Shep had finished splinting Kevin’s leg, a second ambulance, along with a rescue truck, had pulled up to the scene. Grateful for backup, Carol climbed out of the van. “Doris!” she called, recognizing paramedic Doris Pickman, who often transported patients to County General.

“Carol?” Doris jogged over. “What are you doing here? Paramedic ride-along?”

“Something like that.” Carefully avoiding eye contact with Shep, Carol said, “Shep and I just finished splinting a man with an open tib-fib fracture. He’s conscious and alert; vitals are good. Can you transport him? We’ve already got one in our rig; Raul’s monitoring him.”

“Why don’t you guys go ahead? We can take it from here,” offered Doris.

Carol glanced back into the van. “If you don’t mind, I’d like to stay. I’m worried one of the boys in the back may have an aortic injury, and I want to stick around long enough to see him through. Are there more units coming?”

“Should be. Dispatch said there were multiple injuries.”

“Good. Can you take our guy?”

“You got it,” said Doris. She and her partner loaded Kevin onto a backboard and moved him out of the van, making way for Carol to reach the passengers in the back.

Squatting in the narrow aisle, she started with the boy in the middle. “Can you tell me your name?”

“Alex… AJ,” he replied hoarsely. She had to lean close to hear him over the crashing and crunching noises coming from the front of the van, where the rescue squad was using the Jaws of Life to pry off the mangled passenger door. “What’s that noise?”

“Just the firefighters trying to get to the man in the front seat.”

“Lou? Is he okay?”

“Sorry, I’m not sure. What about you, AJ? Are you in any pain?”

“A little.” He grimaced. “My lower back and belly. But... I can’t really feel anything below that. It’s like my legs have gone numb.” As he looked at her, Carol could see the barely-controlled panic in his wide, brown eyes. Her own eyes dropped to the lap belt buckled across his middle. The seatbelt had kept him restrained in his seat, but it may have also done irreparable damage to his spinal cord. She had seen similar injuries before, usually in kids.

“Okay, AJ, I want you to hold really still while we get a collar on you,” she said softly, trying to keep him calm. “Shep?” Again, Shep put on the C-collar while Carol stabilized the boy’s neck. They made a good team, she thought, as she helped maneuver a backboard behind the boy and slide him onto it. “Is there room in the rig to transport more than one?” she asked Shep.

“We can if we strap one to the bench.”

“Should we? Do you think it’ll jostle him too much?” Carol wondered, concerned about worsening a possible spinal cord injury.

Shep shrugged. “It’s a last resort. Look, let’s just move him out of here and reassess the situation outside. There should be more units responding.”

They lifted AJ out of the van and lowered the backboard carefully to the ground. Immediately, the woman who had been driving came running over, screaming, “My son! How badly is he hurt?”

“Hey, Mom,” said AJ, managing a smile.

“Oh, thank God you’re all right, Alex!” cried his mother, dropping to her knees beside him. “What about the other boys? The police wouldn’t let me go back to the van.”

“They took Howie and Kevin. Nick and Brian are still inside. Nick seems okay, but I think Brian’s hurt bad. Hey, Mom, what about Lou? Have they gotten Lou out yet?”

Carol followed the mother’s eyes to the front of the van, where the rescue squad had finally managed to open the passenger door and were working on pulling out the man inside. She could see it was going to be a struggle, as he was obese and unconscious, by the look of it. She hurried over to them. “Need any help here?”

One of the firefighters glanced over at her. “You EMS?”

“I’m an R.N. at County.”

“Maybe you can help. We’re having trouble getting a set of vitals on this guy. He’s too fat - no one can find an artery to check his pulse.”

“I can. Move aside, please.” Carol stepped forward, slipping her stethoscope into her ears once more. “His resps are rapid and shallow… diminished breath sounds on the right,” she said, as she listened to the man’s chest. “Heart sounds are muffled. He’s tachy, and his rhythm’s off. We need to get him out of here and on a monitor.”

She stood back as the firefighters strained to pull the man out of the passenger seat and onto a stretcher. “Let’s put him on fifteen liters 02 by mask,” she suggested, strapping a non-rebreather mask to the man’s flabby face. As she stooped to adjust the flow on the oxygen tank, she heard Shep’s shout.

“CAROL!”

Carol looked up to see a truck careening towards them. She stumbled backwards, flattening herself against the guardrail, as the firefighters scrambled to drag the stretcher out of the way. She heard the squeal of brakes on the wet pavement, but the truck couldn’t stop in time. It smashed into the police cruiser blocking off the scene, sending it spinning out of control. The squad car struck the wrecked van, its front fender wedging underneath the van’s back bumper. The momentum catapulted the van up off the ground. Carol could only watch in disbelief as the van teetered on the edge of the guardrail, just a few feet from where she was standing. Time seemed to stand still as the van hung there, suspended in mid-air, but it must have only been a split second before it continued over the rail and plunged forty feet into the river below.

***

Chapter 3

Nick Carter never saw the truck coming, but he felt its impact. As it crashed into the back of the van, he was thrown forward, his seat belt cutting sharply across his middle for the second time that morning. Before he could catch his breath, his body slammed back against his seat as the van suddenly pitched forward. Then they were freefalling. His stomach dropped like it did whenever he rode the new Tower of Terror ride at Disney World, except this was no theme park attraction.

It was over before he could scream, but he knew they weren’t out of danger yet. Instead, they were in the river.

Water was pouring in through the side door, which had been left open. Nick could see it rising rapidly outside his window as the van started to sink. Up until then, he had been sitting silent and still, in a state of shock after the accident, but as a surge of adrenaline kicked in, he sprang into action. In a panic, he unhooked his seatbelt, prepared to launch himself between the two seats in front of him and escape through the open door. But then he remembered Brian.

He looked over at his best friend, sitting beside him in the back seat. Brian was slumped against his window, still unconscious. But he was breathing. He wasn’t dead. Nick knew he could never leave Brian behind to drown.

“Bri?” He reached out to gently shake Brian’s shoulder. Something inside him pulled uncomfortably when he leaned over, but he ignored the pain. “C’mon, man, you gotta wake up!” He was confident in his own swimming abilities, but he didn’t know if he was strong enough to get both himself and Brian safely out of the van and up to the surface. Still, he had to try. Already, he could feel the van tilting toward one side, as water flooded the interior. His feet were wet and freezing. He picked them up, crouching on the back seat. He unbuckled Brian’s seatbelt and gave him a light shake again, but there was still no response. If the cold water creeping up his pant legs wasn’t enough to shock him awake, Nick didn’t know what would. Like Kevin, he was worried Brian was hurt badly.

You weren’t supposed to move someone who’d been in an accident, Nick knew. He had seen how carefully the paramedics had pulled Howie, Kevin, and AJ out of the van, using backboards and neck braces to keep them from moving around too much and injuring themselves further. He didn’t have that kind of equipment down here, but there wasn’t time to wait for the experts. The van was half-flooded already. In a matter of seconds, they would be underwater.

He pulled Brian to his side, hooking his left arm around his best friend’s body as he used his right hand to pull himself forward, struggling against the force of the freezing water that was flowing in. Just before it hit his face, he took a deep breath and held it as he fought his way between the two middle seats, his heart pounding with barely-controlled panic. He could hardly see where he was going in the murky, fast-moving water, but he knew the way out was to his right, so he headed in that direction, hauling Brian with him.

Once he cleared the door, Nick felt much less claustrophobic. His legs were finally free to kick so he could propel them both to the surface. Soon his head would be above water, and he could breathe again.

But his sense of relief was short-lived. Brian was stuck on something. Nick turned back, his eyes stinging as he tried to see what it was. It took him a few seconds to find that, somehow, one of Brian’s feet had gotten wedged beneath the seat. Try as he might to tug him free, Brian wouldn’t budge.

Nick’s chest was burning from lack of oxygen and the exertion of his efforts. Finally, desperate for air, he was forced to let go of Brian and swim for the surface himself. Despite being a certified scuba diver, it was much more difficult than Nick had thought it would be. He kicked as hard as he could, but the cold water was already affecting his coordination, making his limbs feel heavy and weak. His waterlogged clothing weighed him down; he wished he’d thought to remove his puffy coat before it got wet. But just when he thought he couldn’t hold his breath a second longer, Nick felt a rush of icy cold air, as his head burst out of the water.

He bobbed on the surface for a few seconds, sucking in frantic lungfuls of fresh air. “Nick!” he heard Denise shout from somewhere above him. His survival instinct urged him to swim toward the sound of her voice, but he fought against it.

“Brian’s still down there!” he shouted back. He took one more deep breath and held it as he prepared to go under again. But before he could dive, a strong arm encircled his waist, pulling him back.

“C’mon, kid, I’ve got you!” he heard his rescuer shout, but Nick fought against him.

“No, wait!” he cried, as he felt himself being wrangled toward the shore, away from the sunken van where Brian was still trapped. “We’ve gotta get Brian! Brian’s stuck!”

“The divers are on their way; they’ll get him out,” said the man’s voice in his ear. “Now let me do my job and get you out of here first.”

There was no use continuing to put up a fight; Nick was simply too tired, and the man too strong. He stopped trying to resist and swam alongside him to the shore. A high embankment separated them from the rescue workers waiting on the riverbank above, but someone shouted, “Here, Shep! Grab this!” and tossed a rope down to them. The paramedic, Shep, tied the rope around Nick’s waist. Nick clung to it with numb fingers as he was hauled out of the river, then collapsed on the grassy bank, gasping for breath and trembling all over.

Someone removed his wet coat and wrapped him in a blanket. “We need to get you dried off and warmed up, sweetheart,” said a soft voice in his ear. “Can you stand up and walk with me?”

Nick looked up blearily and recognized the curly-haired woman, Carol, who had helped Kevin, Howie, and AJ earlier. He nodded, climbing shakily to his feet, and she shuffled him over to a waiting ambulance to get checked out.

It was warm in the back of the ambulance, but Nick couldn’t stop shivering. “W-where’s everybody else?” he asked through chattering teeth, as Carol slipped a blood pressure cuff around his arm.

“Already on their way to the hospital,” she replied, inflating the cuff until it was tight. “Don’t worry; they’re in excellent hands.” She paused to listen, pressing her stethoscope to the inside of his elbow. Then she smiled and added, “I work in the ER at County General. My friends there will take good care of your friends.”

Nick nodded again, but it wasn’t the others he was worried about. “What about Brian?” he wondered.

Carol gave him another reassuring smile as she removed the blood pressure cuff. “As soon as I finish checking your vitals, I’ll find out what’s going on, okay? I’m sure the rescue divers will be here soon. Just try to relax and stay calm.”

Nick snorted - like that was going to happen. His heart was still racing, and he didn’t see it slowing down anytime soon, not until he knew Brian was safe.

“What’s your name?” asked the nurse, taking his hand and turning it palm up. She pressed two fingers firmly over his wrist to feel his pulse.

“Nick... Nick Carter.”

Carol continued to fuss over him for a few more minutes, taking his temperature and listening to his chest with her stethoscope. “You’re a pretty lucky guy, Nick. Everything looks okay,” she said, shining a light into his eyes. “Are you in any pain?”

There had been an ache in his belly just after the accident, probably from the seat belt, but it wasn’t bothering him any more. Now Nick just felt numb with cold and exhaustion. “No,” he whispered.

Carol gave him a lingering look, but she seemed satisfied enough with his answer. “All right,” she said, straightening up. “I’m going to go see how those divers are doing. You just sit tight, and I’ll be back soon.” She patted his shoulder and climbed out of the back of the ambulance, shutting the door behind her.

As soon as she was gone, Nick stood up and pressed his face to the small window. It was hard to tell what was happening, but he could see a boat with flashing lights in the water. For what felt like forever, he stared out the window, barely remembering to breathe, until he finally saw the boat start moving toward the riverbank. His breath caught in his throat as he watched a team of rescue workers carry a stretcher off the boat and onto the shore, rushing toward the ambulance with it. Nick’s heart lifted with hope.

The ambulance door opened, and Carol climbed inside. “Nick, I need you to take a seat - and buckle up, while you’re at it,” she said, motioning to a seat off to one side. “We’re going to take you and Brian to the hospital, but you’ll need to stay out of the way while we work.”

“So he’s alive?” Nick asked eagerly, as he sat down and fastened the seatbelt.

Carol didn’t answer. He understood why a second later, when Brian was lifted into the back of the ambulance. Once Nick got a good look at his best friend, his heart sank again. Beneath the straps that held him onto a backboard, Brian’s body was lifeless and still. The two paramedics who scrambled in alongside the stretcher had started CPR: Shep, the one who had pulled Nick out of the river, was pushing repeatedly on Brian’s chest, while the other placed an oxygen mask over Brian’s face and squeezed the bag attached to it every few seconds. Nick knew what that meant. Without a heartbeat and unable to breathe on his own, Brian was basically dead.

Nick buried his face in his hands, not wanting to watch, though he couldn’t help but peek between his fingers to see what was happening. The nurse, Carol, quickly cut off Brian’s wet clothes. She wiped off his upper body with a towel and attached electrodes to his bare chest, working around Shep’s hands as they continued to pump it. Then she switched on a small monitor, which showed a green line that spiked with each compression.

“Let’s pause and check his rhythm,” she said, and Shep stopped pumping. Nick held his breath as all eyes turned to the heart monitor, but the green line immediately flattened, and Nick felt his lungs deflate. “Asystole,” said Carol. “Resume compressions.”

As Shep started pumping Brian’s chest again, the ambulance’s engine suddenly roared to life. Nick could hear the wailing siren and see the flicker of strobe lights reflecting against the window glass as they raced away from the scene. He clutched the edge of his seat and hoped it would be a short ride to the hospital.

Carol inserted an IV into Brian’s arm and injected it with a syringe of something. “One amp of epi in,” she said. Nick watched the heart monitor hopefully, waiting for something to happen, but there was no change.

“He’s dead, isn’t he?” he whispered, hot tears stinging his eyes. He didn’t even bother to wipe them away.

Shep shook his head, his strong arms still pumping vigorously. “There’s a saying we have in the medical community,” he replied, panting slightly from the physical effort he was putting forth. “‘You’re not dead until you’re warm and dead.’ If you’re gonna drown, kid, do it in cold water - mild hypothermia actually helps in these kinds of situations. I’ve seen drowning victims brought back after being down a lot longer than your friend here has. So no, he’s not dead until we say he’s dead. Right, Hathaway?”

Carol hesitated. “His condition is very serious,” she said neutrally, apparently not wanting to give Nick false hope by agreeing with Shep.

Still, Nick felt somewhat encouraged. If anyone could survive something like this, it was Brian. He was one of the strongest people Nick knew - small in stature, but scrappy as hell. In a fight for his life, he would bet on Brian to win.

“C’mon, Frick,” he begged, forcing himself to look at Brian’s blank, ashen face. The sight of it chilled him to the bone, and he began to shiver again. “Come back to me, bro.”

There was no response, no sign that his best friend in the whole world was still alive, but Nick wasn’t ready to give up hope. He knew what Brian would do in his situation, were their roles reversed: Brian would pray. Nick had never been particularly religious, but in that moment of desperation, he was willing to try anything. As the ambulance sped toward the hospital, he squeezed his eyes shut, clasped his hands together, and silently prayed for God to make a miracle happen there.

***

 

Chapter 4

The sun was up by the time the call came in to County General’s emergency department, but it was pitch black inside the exam room where Dr. Mark Greene was sound asleep. The door burst open suddenly, flooding the small room with fluorescent light from the hallway.

“Dr. Greene?”

Mark stirred slightly at the sound of his name, but kept right on snoring.

“Dr. Greene!”

The shout startled him awake. “What is it?” he mumbled, without opening his eyes.

“We’ve got a major trauma coming in,” replied nurse Lydia Wright from the doorway. “MVA involving a van.”

Mark lifted his head, squinting into the bright light. “How many?”

“At least four on the way, but there may be more. We’re gonna need all hands on deck.”

“What’s their ETA?” he asked, checking his wristwatch. The numbers blurred before his eyes.

“Five minutes out.”

Mark reached for his glasses and slipped them onto the bridge of his nose. “All right,” he sighed, untangling his stethoscope from the oxygen line over his head as he sat up. “I’ll be right there.”

So much for trying to catch a few winks before the second half of his double shift began, he thought with regret as he staggered down the hall, stretching his arms over his head to work out the kinks in his back. Such was the life of an emergency room physician. Even as an attending, he was still perpetually exhausted.

He had thought, naively, that having a tenured position at the hospital would make his life easier, not harder. What he hadn’t counted on was the added responsibility that came with the job - all the administrative duties, the extra meetings, the paperwork. And it didn’t help that he had to commute between Chicago and Milwaukee several times a week just to see his wife and daughter. No wonder he was tired.

Several of his colleagues were already waiting in the ambulance bay, gowned up and ready for the slew of trauma patients to arrive. “Oh, Mark, there you are,” commented the new chief resident, Kerry Weaver, shifting her weight on her crutch. “We were beginning to wonder if you’d ever wake up.”

Mark forced a smile. “I’m up,” he said shortly. Behind Kerry’s back, Dr. Susan Lewis rolled her eyes, while pediatrician Doug Ross caught his eye and winked. They were Mark’s closest friends among the ER staff, and he knew it had been a struggle for them both to adjust to working with the authoritative Weaver. Her appointment as chief resident hadn’t been his idea, but since he had been the one to approve it, he got all the blame.

“What I’m wondering is why it’s so damn cold out here!” said Susan, hugging herself to keep warm as she bounced up and down on the balls of her feet. “This feels more like winter than fall.”

“Actually, Susan, the autumnal equinox isn’t until tomorrow, so technically it’s still summer,” put in Kerry matter-of-factly.

Doug snickered. “Welcome to the Midwest, where you can enjoy all four seasons in a single day.”

Susan groaned. “I should have done my residency in the desert.”

“We’ll all warm up soon enough,” said Mark, as the distant sound of sirens grew steadily louder. “They’re almost here.”

As an ER doctor, this was what he lived for. When the first of four ambulances rounded the corner, red and blue lights flashing eerily through the fog, Mark was in his element. “What have we got?” he asked, as paramedic Doris Pickman jumped out of the back to begin unloading her patient.

“Kevin Richardson, twenty-three, open tib-fib fracture following a single-vehicle MVA: van versus guardrail,” rattled off Doris. “Mr. Richardson was awake and responsive on scene, with no other obvious injuries. He’s slightly tachy at 110; otherwise, vitals are normal. We gave him ten of morphine in the field.”

“Why don’t you take him, Susan? Trauma 2’s open,” said Kerry, her eyes already surveying the second ambulance to arrive. As soon as the rig skidded to a stop, the driver jumped out and raced around the back, opening the doors to reveal two paramedics performing CPR on the patient inside. “I’ll get this next one.”

Mark braced himself, half-expecting Susan to complain about Kerry assigning her the less interesting patient and taking the more critical one for herself. But when Susan saw the morbidly obese, middle-aged man being lowered - with difficulty - out of the back of the ambulance, she just smiled. “Sure, Kerry,” she said, turning to her patient, who even Mark had to admit fit the description of “tall, dark, and handsome” to a T. “Hi, Mr. Richardson, I’m Dr. Lewis,” he heard her say as she helped roll the young man with the broken leg inside. “We’re going to take good care of you.”

Mark couldn’t help but chuckle to himself as he and Doug hurried to help the paramedics unload the big guy. “Lou Pearlman, forty-one, front seat passenger, found unresponsive at the scene,” panted one of the medics, struggling with the weight of the man wedged between the safety rails of the stretcher. “Initial rhythm was V-tach. We tried to cardiovert him, but lost his pulse in the ambulance.” As soon as they got the gurney’s wheels onto the ground, she began bagging the patient again while her partner resumed chest compressions.

“How long has he been down?” Kerry asked.

“Five minutes.”

Mark watched the man’s pale, flabby belly bounce with the force of each compression. Poor fat guy didn’t look like he had much of a chance. “You sure you got this, Kerry?”

“I think I’ve got it covered, Mark, thanks. There are supposed to be at least a couple more coming,” said Kerry, limping alongside the gurney as fast as her crutch could carry her. “Let’s take him to Trauma 1.”

Mark and Doug looked at each other. “And then there were two,” said Doug, smirking.

Mark glanced at his watch. “We expecting any pedes cases?”

Doug nodded. “At least one, maybe two teenagers.”

It didn’t take long for the last two ambulances to arrive. “AJ McLean, seventeen, possible spinal cord injury with loss of sensation in the lower extremities,” said one of the paramedics who unloaded the next patient.

“This one’s all yours, Doug,” Mark told the pediatrician. “If you see Harper, have her assist - it’d be a good opportunity for her to learn how to do an ASIA Exam.”

“Will do,” replied Doug as he took the teen inside.

Mark turned his attention to the other ambulance, where the paramedics were unloading yet another young man. “Howie Dorough, twenty-two, suffered facial trauma from striking the window glass. Complains of head and neck pain, but alert and oriented on the scene, no reported LOC. Gave him five of morphine for the pain and started him on supplemental O2, 15 liters per minute. GCS 15, heart rate 92, BP 130/90, resps 20, pulse ox 98,” one of the medics relayed on the way in. The patient’s vital signs were all within the normal range, but that didn’t mean much to Mark, who knew how quickly head injury victims could decompensate. He wasn’t going to take any chances.

“What’s open, Chuny?” he asked one of the nurses, who was waiting for him just inside.

“Exam 8,” Chuny replied, grabbing one side of the gurney. Together, they wheeled the patient into the empty exam room where Mark had been enjoying his nap ten minutes earlier. He looked longingly at the bed before they transferred the accident victim onto it.

“I’m Dr. Greene,” Mark introduced himself, leaning over the young, olive-skinned man to take a closer look at his injuries. “How are you doing, Mr. Dorough?”

“O-okay, I guess,” he answered shakily, as the nurses began cutting off his clothes. “You can call me Howie.”

Mark offered him a reassuring smile, noting a nasty scalp laceration on his forehead and bruising around his swollen right eye. But before he could assess the patient’s head trauma, he had to start with the basic ABCs: airway, breathing, and circulation. “We’re going to take good care of you, Howie,” he promised, as he slipped his stethoscope into his ears. “Any chest pain or trouble breathing” he asked, pressing the diaphragm of his scope to the man’s chest to listen to his heart and lungs.

“No.”

Mark nodded. Everything sounded as it should. “Good breath sounds bilaterally and normal heart tones,” he reported. With a gloved finger, he gently pried up the patient’s puffy eyelid and shone his penlight into Howie’s eyes to observe their response. “Pupils equal, round, and reactive,” he added to Chuny, who made a note on the man’s chart. “Are you having any trouble seeing? Any blurred or double vision?” he asked Howie.

“Not really.”

Mark frowned. “How many fingers am I holding up?” he asked, raising his index finger.

“One.”

“Good. Follow my finger without turning your head.” He moved his finger slowly back and forth in front of Howie’s face, watching the way his eyes tracked it. Satisfied that there was no injury to the eye itself, Mark moved on with the rest of his examination. “Any numbness or tingling?” he asked, as he palpated the bony structures in the patient’s face.

Howie winced as Mark pressed against his zygomatic bone, just beneath the eye socket. “No, it just hurts.”

“Sorry,” said Mark. He felt along both sides of Howie’s mandible, making sure it was intact. “Open your mouth please.” He looked inside the man’s mouth for broken teeth, but didn’t see any signs of trauma. “Good. You can close now.” He watched the jaws as they shut; they seemed to be properly aligned. “Do you have pain or numbness anywhere else?”

Howie started to shake his head, but the cervical collar around his neck prevented him from moving it. “No,” he whispered. “How long do I have to wear this thing?”

“Just until we make sure you haven’t injured your spine,” Mark replied. “Do you have any numbness or tingling in your arms or legs?”

“My arms are sort of tingly feeling,” Howie admitted, grimacing.

Mark nodded. “Squeeze my hand,” he requested, picking up Howie’s right hand first, then his left. The grip in both was strong, which assured him that the nerve function was intact. “Wiggle your toes, please.” He watched Howie’s feet move. “Very good. You may have some whiplash, but it doesn’t seem like anything too serious.” Looking at Chuny, he added, “Let’s get a cross-table C-spine, head, and chest CT, orbital films, and a full trauma panel.”

The nurse nodded as she wrote down his orders. “I’ll call Radiology.”

“Thanks.” Mark turned back to his patient. “As soon as Radiology is ready, we’re going to send you for some X-rays and a CAT scan to make sure your head and neck are okay. Once you’re cleared, we’ll be able to take that collar off, okay?”

“Okay… thanks,” Howie said.

“No problem,” Mark replied, now palpating the patient’s abdomen. “Tell me if you feel any pain while I’m pressing on your belly.”

“Okay. Have you heard anything about the others?”

“The others?” Mark asked, as he continued the exam.

“My friends who were with me in the van,” said Howie, starting to sound impatient. “AJ... Nick… Kevin… Brian… Denise… and Lou. Are they okay?”

“Belly is soft and benign - no rebound tenderness or guarding,” Mark reported to Chuny, who wrote down his notes. To Howie, he said, “I’m not sure, but I’ll find out for you as soon as we’re done here.” He tried to keep his face neutral, but he couldn’t help but think about what bad shape the big guy, Kerry’s patient, had been in. He knew not all of Howie’s friends were going to be okay.

“That would be great. Thank you,” Howie said, his impatience giving way to politeness again.

“Of course.” Mark moved to his pelvis, making sure there were no signs of injury there. “So how did the accident happen?” he asked, as he poked and prodded.

“I don’t know… It happened so fast.” Howie swallowed hard. “The fog was really bad. Denise was driving; I don’t think she could see. She must have lost control or hit something… I don’t know. Hey, do you know where she is? She’s AJ’s mom; maybe she knows how he’s doing.”

“I don’t, but I’ll find out,” Mark promised. “Just give me a few more minutes. It doesn’t hurt at all down here, does it?”

“No, no, I feel fine,” Howie insisted. Mark could tell he was starting to get anxious again.

“Tell me about your friends,” he said, trying to keep Howie calm. “Are you all from Chicago?”

“No… Orlando.”

“Florida? Wow. My wife and I want to take our daughter down there someday, to Disney World. She’s six,” said Mark. “Were you here on vacation?”

“No, work,” Howie replied. “We’re a vocal harmony group. We’re touring right now, trying to promote our first single. We were supposed to sing on a radio show this morning.”

Mark raised his eyebrows. “Really? Wow. What’s your group called?”

“The Backstreet Boys.” Howie smiled briefly and closed his eyes for a few seconds. When he opened them again, they were full of tears. “Please, do you know anything about the other guys? Are they okay?”

Mark looked up at Chuny, who gave him a significant glance. He could tell she was thinking the same thing he was: asking the same questions over and over again was a sign of brain trauma. It was probably just a concussion, but it could be something worse. “You wanna call Radiology again and put a rush on those scans?” he asked her casually.

Chuny nodded. “I’m on it,” she replied, already reaching for the phone. “Radiology’s ready for him,” she told Mark a few minutes later, when he had finished his exam.

“Perfect.” Mark smiled down at the patient. “Howie, Chuny here is going to take you for those scans now, while I go check on your friends. Sound good?”

Howie offered a grateful smile in return. “Thanks, Doc.”

“Don’t mention it.”

As Chuny wheeled Howie toward the radiology department, Mark wandered down the trauma hallway. He stopped outside Trauma 2, where he could see Susan working on the young man with the broken leg. It looked like she had everything under control, so Mark moved on to Trauma 1.

Inside the trauma room, the efforts to resuscitate the fat man on the table were slowing down. “How long since the last epi?” Kerry asked, as one of the nurses, Malik, continued chest compressions. Mark could tell he was starting to tire; sweat poured down his dark face.

“Two minutes,” Lydia replied. “Do you want to try another dose?”

Kerry hesitated, her eyes on the cardiac monitor. “No. Hold compressions, please.” Malik removed his hands from the man’s flabby chest. Mark watched the monitor flatline.

“Asystole,” said Lydia. “Still no pulse.”

“How long has he been down?” Mark asked, peering over Lydia’s shoulder at the patient’s chart.

“Almost thirty minutes. I’m calling it,” replied Kerry, looking up at the clock on the wall. “Time of death… 6:59.”

Mark sighed. No time to sleep now. His second shift started in one minute.

***

Chapter 5

One of Susan Lewis’s strengths was the ability to stay calm in a crisis. It was a skill she had developed during her childhood, having grown up as the most stable member of her dysfunctional family, and so far, it had served her well in her career in emergency medicine. Battles between life and death were fought on a daily basis within the walls of County General’s emergency room, and as a third-year resident, Susan often found herself on the frontlines. Every day she went to work, she was faced with some kind of critical illness or catastrophic injury, which she was expected to treat. On a typical day, she did so without batting an eye or breaking a sweat. Nothing much fazed her anymore.

In a way, she supposed she had become desensitized to the tougher parts of her job - not only the blood and gore and other bodily fluids, but the feelings that went along with watching people in pain. It wasn’t that she no longer had empathy for her patients and their families, many of whom she met on one of the worst days of their lives. It was just that she had learned to compartmentalize, to keep her emotions contained so she could fulfill her duties with the cool logic expected of an ER doctor.

Some days it was easier than others. Looking down at the distraught man lying on the gurney in front of her, it was hard not to feel bad for him. Tears flowed freely from his green eyes while she tended to his leg wound. It was a gruesome injury; his tibia bone had broken clear through the skin of his lower leg, which was covered in blood. “I’m sorry, Mr. Richardson,” Susan apologized as she irrigated the wound with saline, washing away debris and bacteria that could cause an infection. “I know this hurts.”

“It’s not just that,” her patient replied, shaking his head. “I’m worried about my friends… and my cousin.”

“Your cousin was in the crash with you?” she asked, continuing the conversation while she worked. If she could keep him talking, she might be able to take his mind off the pain until enough time had passed to give him more morphine.

“Yeah… his name’s Brian. Brian Littrell. Do you know if he’s been brought in yet?”

“I’m not sure, but I can find out for you when I finish here,” Susan promised him. “The radiology department should be ready for you soon. I’ll ask about your friends while you’re getting X-rays done.”

“Thanks,” he replied gratefully.

The phone in the room rang, and Connie, the nurse who was assisting Susan, hurried to answer it. She spoke softly for a brief minute, then came back to the foot of the bed. “That was ortho. We’re gonna be waiting awhile on that consult; the orthopod who’s supposed to be on call is stuck in traffic.” She rolled her eyes.

Susan nodded, pausing to press her fingers lightly against her patient’s ankle. She frowned in concentration as she felt for a pulse in his posterior tibial artery, wanting to make sure his circulation hadn’t been compromised by the injury before she answered Connie. Once she was satisfied that blood was still flowing through the patient’s foot, she replied, “That’s okay. He’s got good foot pulses, so I’m not too worried right now. We’re still waiting on Radiology anyway.”

“Orthopod?” her patient asked, raising one of his prominent eyebrows. “Sounds like some sort of prehistoric animal.”

“It does, doesn’t it?” said Susan with a smile, as she went back to irrigating his open fracture. “But it’s just short for ‘orthopedic surgeon.’ We called for one to come take a look at your leg.”

He grimaced. “I’m gonna need surgery?”

Her eyes followed the stream of blood and irrigation solution as it flowed down his shin and dripped into the collection container she had set on the floor in front of her. Below the fracture site, his leg was bent at an unnatural angle, the foot and ankle turned sharply to the left. Glancing up, she gave him a sympathetic nod. “Unfortunately, yes. You almost certainly will.”

“Great,” he groaned, dragging his hand down the front of his face. He had to be close to her in age, maybe a few years younger. For all she knew, it was his first time facing major surgery.

“You’re going to be okay, Mr. Richardson,” she tried to reassure him. The break was a bad one, but she had seen worse. At least his leg seemed salvageable.

“Please… call me Kevin,” he replied, the corner of his mouth twitching into a tiny smile.

Susan nodded. “Of course… Kevin.”

“How long of a recovery am I looking at here, Dr. Lewis?”

“Susan,” she said before she could help herself, smiling back at him. “Since we’re using first names now… mine’s Susan.” Out of the corner of her eye, she saw Connie raise her eyebrows. It wasn’t like Susan to flirt with a patient - but then, it wasn’t often that a patient who looked like Tom Cruise came into County’s ER. Feeling herself blush, Susan quickly continued, “As far as your recovery time goes, that’s really a question for the orthopedic specialist... but if I had to give an estimate, I’d say you can expect to be back on your feet in four to six months.”

“Six months?” Kevin repeated. “Damn… that’s a long time to be laid up.”

“It may not take that long. Let’s wait and see what the orthopedic surgeon has to say before you worry.” Lowering her head, she went back to work. “What do you do for a living, Kevin?” she asked, as she finished irrigating his leg.

“I’m an entertainer,” he answered. “I’m part of a male pop vocal group with four other guys. They were in the van with me…”

Glancing up again, Susan saw fresh tears welling in Kevin’s eyes as his thoughts went back to his friends. “Male pop vocal group?” she repeated, hoping to distract him from worrying about them. “Like a barbershop quartet?”

“Sort of… we do sing a capella sometimes, but we also dance.” Kevin paused, then added, “Picture New Kids on the Block, but with better voices.”

Susan laughed. “New Kids on the Block, huh? There’s a name I haven’t heard in a while.” She wiped away the excess fluid from around his wound. “What’s your group called?”

“The Backstreet Boys,” he replied, somewhat grudgingly. Susan could see why - it was a pretty corny name.

“Ah, I see,” she said, smiling. “So you’re, like, from the street behind the block where the New Kids lived?”

Kevin groaned. “Something like that.” He lay his head back and looked up at the ceiling. “It’s gonna be hard to perform with my leg like this…”

Susan winced and shook her head. “Yeah, I definitely wouldn’t recommend doing that.” She wrapped his shin with a fresh sterile dressing soaked in saline, wanting to keep it covered until the consulting surgeon arrived to examine it. “How does that feel?” she asked when she finished.

“All right, I guess,” Kevin replied with a shrug. “I don’t feel much, thank God.”

“You can thank the morphine for that,” said Susan with a wry smile. “Let one of us know if the pain starts to get worse again, okay?” She rose from her stool and stripped off her gloves. “I’m going to go see what I can find out about your friends,” she added, as she walked across the room to wash her hands. “Connie will stay here with you while we wait for someone to take you to Radiology.”

“Sounds good,” said Kevin gratefully, his green eyes following her to the door. “Thanks, Susan.”

“You’re welcome, Kevin,” Susan replied and left the room with a smile on her face. It quickly faded when she saw the body being wheeled out of Trauma 1, where Kerry Weaver had just pronounced her patient’s death. “Please tell me that wasn’t the same guy from the MVA,” she begged Mark, who was hunched over the desk across from Curtain Area 2, catching up on his paperwork.

“I would, but I’d be lying,” he said, giving her a grim look as the sheet-covered gurney rolled past. “How’s your guy?”

Susan sighed. “Stable, but worried about his friends. I promised I’d find out how they’re doing for him.”

“I sent one off to Radiology for a head CT a little while ago,” replied Mark, standing up with his clipboard in hand. “He may have a mild TBI, but he was conscious and talking. Should be okay.”

“That’s good,” Susan said with a nod. She walked alongside him as they headed toward the admit desk down the hall. “Have you heard anything on the others? There were at least five.”

“Doug’s with one of them - kid with a suspected spinal cord injury,” said Mark, making Susan cringe. “I don’t know about anyone else.”

As if on cue, they suddenly heard the desk clerk call, “Dr. Greene!”

“What’s up, Jerry?” Mark asked, as they hurried ahead to the admit desk, which was always a hub of activity.

“Carol Hathaway just called. She’s with Unit Forty-Seven, bringing in two more patients from that MVA on the bridge. One’s stable, but the other’s in full arrest after being pulled out of the river. They’re ten minutes out.”

“Oh god,” said Susan, her heart sinking as she thought of Kevin. Unbeknownst to him, he had already lost one of his friends. Now it looked like he was about to lose another.

“You wanna run this one, Susan?” Mark offered.

Steeling herself, Susan nodded. “Sure. Let’s get a trauma room ready. I want some heated saline on hand in case he’s hypothermic. It’s freezing out there this morning; I can’t imagine the water’s much warmer.”

“What’s open, Jerry?” asked Mark.

“Both trauma rooms are already being used,” replied the clerk with an apologetic shrug. “Try Curtain 1.”

Susan shook her head, knowing they would need the more advanced equipment available in a trauma room. “They just took the dead guy out of Trauma 1. We’ve got ten minutes. Let’s go!”

They rushed back to Trauma 1, where the nurses and custodial staff were still cleaning up after the last patient. “We’re gonna need this room,” Mark told them. “We’ve got another cardiac arrest coming in.”

As the team scrambled to get the room ready, nurse Lily Jarvik popped her head through the door. “Dr. Lewis? They’re pulling up with your patient now.”

Susan rushed after her to the ambulance bay, where paramedics Shepard and Melendez were already unloading a stretcher from the back of their rig. She recognized the dark, curly hair of ER nurse manager Carol Hathaway, who had climbed atop the stretcher, straddling the patient so she could continue performing high-quality chest compressions during transport.

“Twenty-year-old male in asystolic arrest after being submerged in the river for approximately twenty minutes following an MVA on the bridge,” rattled off Shep as they rolled the stretcher inside. “We’ve already given three rounds of epi, but there’s been no response.”

“Take him to Trauma 1,” Susan told the paramedics, helping guide the gurney. The boy lying on it looked lifeless and gray. “What’s his name?” she wanted to know.

“Brian,” said Carol breathlessly, as she pumped the boy’s chest. “Brian Littrell.”

Susan felt her heart sink further when she recognized the name of the cousin her last patient had been so worried about. Judging by what she had just heard, he was likely a goner, but she was bound and determined to try her best to bring him back.

Once inside the trauma room, Carol climbed off the stretcher, as Susan coordinated the patient’s transfer. “On my count: one, two, three!” Her team slid the backboard onto the awaiting gurney in one swift, smooth move. “Lily, take over compressions, please,” she ordered, as Carol hooked him up to the hospital’s cardiac monitoring equipment. Immediately, the monitor let out a loud wail as it registered a flatline.

In the midst of the commotion, Susan heard a small voice say, “Can you save him?” She turned and saw a teenage boy standing in the doorway, watching with wide, scared eyes. He was wrapped in a blanket, and his wet, blond hair was plastered to his head.

“Is this the other patient you were bringing in?” she asked Carol, tipping her head toward the boy.

Carol nodded. “His name’s Nick. He was still in the van with Brian when it went into the water. He was able to free himself, but couldn’t get his friend out,” she filled them in quietly. “I’ll take care of him.” She walked over to the younger boy and put a comforting arm around his shoulders. In the background, Susan could hear her saying, “Come with me now, Nick. We need to let a doctor take a look at you.”

“No, please,” Nick protested, shaking his head wildly. “I wanna stay with Brian!”

The nurse hesitated, looking from Nick back to Brian. Susan could see the sympathy in her eyes. “Did anyone examine him in the field?” she asked Carol.

Carol nodded. “I did. Normal vitals, no obvious signs of injury.”

“Then let him stay,” Susan decided. In an undertone, she added, “That way, he gets to say goodbye, and this poor kid won’t have to die alone.” She met Mark’s eyes across the gurney, and he gave her a grim nod of approval.

Tightening her arm around Nick, Carol slowly brought him closer to the foot of Brian’s bed. “You need to stand back here so we have room to work,” she explained. “We’re going to do everything we can to help Brian.” Nick nodded, watching the flurry of activity around his friend with a look of horror on his face.

“Good luck, Hathaway,” Susan heard Shep say to Carol as he and Melendez cleared out of the crowded trauma room. She couldn’t help but notice how close Carol seemed to be getting with the paramedic these days and made a mental note to ask her about it when they weren’t in the middle of a code.

Mark cleared his throat. “He needs an advanced airway, Susan. Want me to intubate?”

“No, I will,” said Susan, snapping on a pair of sterile gloves. She moved to the head of the gurney, where Lydia had set up an intubation tray. “Laryngoscope, please.” She held out her gloved hand, and the nurse placed the tool neatly into it.

“What are you doing to him?” Nick asked, his voice shaking.

“Dr. Lewis is putting a tube down Brian’s windpipe to help him breathe,” Carol told him in her usual calm tone.

Susan could tell it was going to be a tricky intubation. She couldn’t tilt the patient’s head back or lift his chin because of the rigid cervical collar wrapped around his neck, yet she didn’t dare remove the collar until his spine could be cleared. If he had broken any vertebrae in the accident, moving him the wrong way could result in permanent paralysis. It was a risk she wasn’t willing to take.

Instead, she pried his jaws apart and bent down, trying to find the best angle to visualize the back of his throat. White foam bubbled up from his esophagus each time Lily pushed down on his chest, filling his mouth and obstructing Susan’s view. “I need suction!” she demanded. “I can’t see a damn thing.”

Lydia stuck the suction wand into the patient’s mouth and sucked up as much of the foamy liquid as she could to clear his airway before Susan tried again.

“That’s better - thanks.” She inserted the blade of the laryngoscope, using it to push his tongue to the left, out of her line of sight, and lift the epiglottis. “Number eight ET tube,” she requested once she could see his vocal cords. Carefully, she advanced the tube into the opening between them. “Okay, I’m in. Bag him.”

As Lydia went back to ventilating Brian with an Ambu bag, Susan slipped her stethoscope into her ears so she could listen to his lungs. “Good chest rise and bilateral breath sounds,” she observed, confirming her placement of the tube. “Keep bagging. It’s been about two minutes - Mark, take over compressions for Lily, please. Carol, can you get a core temp?”

“Ninety-three degrees,” Carol called out after a minute, as Mark continued CPR.

“That’s only mildly hypothermic,” Susan noted, not sure whether this was a good or bad sign for her patient’s prognosis. In her head, she could hear her medical school professors reciting the old adage, “Nobody is dead until they’re warm and dead,” as they stressed the importance of continuing resuscitation efforts in pulseless hypothermic patients until their body temperature had been brought back up to at least thirty degrees Celsius - eighty-six degrees Fahrenheit. But Brian’s temperature, while still several degrees below normal, was already above the threshold for declaring someone “warm and dead.” He wasn’t a popsicle, but he might be a vegetable if she did manage to bring him back - a possibility that was looking less and less likely with each passing minute.

“Do you want warming blankets?” offered Carol. “Heated saline?”

After a moment’s hesitation, Susan nodded. “Yeah. Let’s run in a liter and switch him over to heated, humidified O2 - see if it helps.”

“Ahem.” It was hard not to notice Kerry Weaver clearing her throat. Fighting the urge to roll her eyes, Susan turned her head and saw the new chief resident standing in the doorway. “I’m sorry to interrupt,” said Kerry as she walked into the trauma room, “but I couldn’t help overhearing. Susan, you may not have read the study published last year on the positive effects of mild hypothermia after cardiac arrest in canines.”

“Canines,” Susan repeated, raising her eyebrows.

Kerry nodded. “The results were quite promising,” she continued conversationally. “The dogs in whom mild hypothermia was induced immediately after cardiac arrest had improved cerebral outcome compared to the control group.”

“Well, in that case, hopefully my patient will be back to shaking paws and fetching sticks real soon,” Susan replied sarcastically, flashing Kerry a close-lipped smile.

Kerry gave her a pointed look. “Hypothermia helps protect the brain from hypoxic injury. It may be better to keep your patient in a state of mild hypothermia until his heart is beating again.”

Susan hesitated. On one hand, she would do anything to save her patient. On the other hand, she hated to admit that Kerry might be right. “Mark?” she asked, appealing to the attending in the room, whose judgment mattered more than either resident’s.

“Kerry has a good point,” Mark said as he gave compressions, barely glancing up.

“If you say so,” Susan sighed, annoyed at Kerry for constantly correcting her and at Mark for always seeming to side with the esteemed Dr. Weaver. “Cancel the heated saline and O2.”

“What drugs have you administered?” Kerry wanted to know next.

“Nothing yet; I just finished intubating him,” said Susan, feeling defensive.

“Lily, let’s give him one milligram of epinephrine, IV push, and then get blood drawn for labs - I want an AGB, CBC, glucose, lytes, lactate level, and coag panel,” Kerry ordered, pulling on a pair of gloves as she approached the gurney.

Susan bristled. “Excuse me, Kerry, but I’m running this code.”

“So run it,” snapped Kerry. “You need to be able to multitask in order to successfully manage a resuscitation team.”

Susan couldn’t resist rolling her eyes that time. “When was his last epi?” she asked Carol, ignoring Kerry.

Carol looked back at the clock. “It’s been at least five minutes.”

“Okay. Lily, go ahead and give him another amp of epi, then order those labs,” said Susan. “Let’s continue CPR for two more minutes and see how he responds. I’ll trade you places, Mark.” She positioned herself on the side of the gurney opposite the attending and planted her hands firmly over the patient’s sternum the second Mark pulled his away. She pushed hard and fast, imagining it was Dr. Weaver’s face she was pummeling instead of this poor young man’s chest.

“We’re going to need some more epi in here,” said Lily, as she took a tiny glass vial out of the top drawer of the crash cart. “We’re almost out.”

“This is our second cardiac arrest case in a row in this room,” Kerry replied. “I doubt the nurses had time to restock after the last patient before this one was brought in.”

As she bent over Brian’s body, Susan rolled her eyes again. Was Weaver trying to blame her for that, too? “We didn’t have a choice, Kerry,” she said, already breathing hard from the physical effort of performing chest compressions. “We needed the room.”

“I’ll go get some more epi from Trauma 2,” Carol volunteered, ducking through the double doors that separated the two trauma rooms.

“Carol?” Susan heard Kevin say before the doors swung shut again.

“Oh god,” she groaned, looking up from the lifeless body beneath her hands. “The guy in 2 is this one’s cousin.”

“Kevin?” Susan had almost forgotten their friend Nick was still in the room until he spoke for the first time in several minutes. “Is that Kevin next door?”

“Hey, wait-” she started to say, but before anyone could stop him, Nick followed Carol into the other room.

“Kevin!” Susan heard him cry. “Are you okay?!”

“Nick! Thank god you’re all right!” came Kevin’s reply. “I’ve been so worried about y’all. No one will tell me anything.”

She couldn’t hear what Nick said next; the doors had closed again. But when Carol came back in, carrying enough ampules of epinephrine to fill both hands, Susan saw Kevin crane his neck to look through the open doors into the next room. His eyes locked with hers for a brief moment before they lowered to the body on the bed.

“Brian!” Kevin cried. “Oh god, Brian!”

Carol looked back in sympathy as the doors swung shut, cutting him off from his cousin. “They’re related,” she said quietly, as she added the clear vials of medication to the drawer of the crash cart. “I didn’t realize he was right next door.”

“I did,” Susan sighed, shaking her head. “I treated him, too. The poor guy’s tibia is literally sticking out of his shin, and all he cared about was whether his cousin and their friends were okay.”

“That’s exactly how he acted at the scene of the accident, too,” said Carol. “They seem really close.”

Considering this, Susan looked at the large window in the wall separating the two trauma rooms. It had horizontal blinds that could be opened during busy traumas, when staff members might be moving back and forth between multiple patients, but were usually kept closed to protect the patients’ privacy. “Why don’t you open the blinds so he can see what’s going on?”

“And be even more traumatized?” Kerry interjected. She could always be counted upon to express her disapproval.

“Actually, Kerry, studies have shown positive effects of families being present during CPR,” said Susan snarkily, pumping faster. “Or maybe you missed those articles.” She glanced up and saw with satisfaction that Kerry’s face was as red as her hair.

“Watch it, Susan,” said Mark in a warning tone. “You’re hardly giving his heart enough time to fill.”

With a sigh, Susan slowed down her rate of compressions, concentrating on keeping them deep and steady. Mark was right; she had gotten carried away. It wasn’t like her to lose control in the middle of a trauma, but Kerry Weaver seemed to bring out the worst in her. “How long since the last epi?” she asked.

“Almost two minutes,” Lily answered.

“Okay… let’s see if it had any effect.” Susan stopped CPR just long enough to look hopefully at the heart monitor, but the green line running across the black screen remained stubbornly flat. Her face fell. “Still asystole,” she sighed. “Let’s try atropine… one milligram.”

“Susan, why don’t you take a break and go talk to the cousin?” Mark suggested, as Lily administered the medication. “I’ll get back on the chest.”

“Okay,” she reluctantly agreed, removing her hands so Mark could resume compressions from the other side of the gurney. Her arms felt like limp spaghetti as she walked around the foot of the bed and over to Trauma 2.

Nick stood next to Kevin’s bed now, looking like a lost child as he clung to his hand. “Dr. Lewis… Susan,” said Kevin, looking desperately at her. “That’s my little cousin in there. Please… don’t let him die.”

Susan swallowed hard. “We’re doing everything we can,” she assured him, “but so far, Brian hasn’t responded. I want to prepare you for the possibility that we might not be able to bring him back.”

Kevin shook his head. “You don’t know Brian like I do. He may be small, but he’s the strongest person I know. He’s a survivor,” he insisted, his green eyes swimming with tears. “When he was five, he got real sick with an infection that went into his heart. The doctors told his parents to start planning his funeral because they didn’t think he was gonna make it. At one point, his heart even stopped for thirty seconds… but they brought him back. It was a miracle.”

Susan offered him a sympathetic smile. “It’s been more than thirty minutes this time,” she told Kevin as gently as she could. “Even if we manage to get his heart beating again, his odds of making a meaningful recovery-”

“Don’t count him out yet,” Kevin cut her off. “He can come back from this, too. I know he can.” Next to him, Nick was nodding adamantly, as tears poured down his pale face.

Susan’s heart broke for both boys. “We’re not giving up,” she promised them, watching her colleagues through the window. “We’re gonna keep working on him for as long as we can.” But as she walked back to Brian’s bedside, where the resuscitation effort was still in full swing, she knew there would come a point when she had to call it off, when it simply wasn’t feasible to continue wasting time and resources on a patient with no chance of recovering.

“Any response to atropine?” she asked hopefully, looking around at the rest of her team. They had rotated roles: Kerry was performing CPR now, her crutch propped against the side of the gurney, while Mark ran the code. Lily had taken Lydia’s place at the head of the bed, squeezing the Ambu bag once for every five compressions to keep Brian ventilated. Lydia manned the crash cart, ready to administer more meds at a moment’s notice. Carol acted as recorder, her eyes moving between the clock on the wall and the chart in her hand, where she was making notes.

“Nothing,” said Mark, shaking his head. “Still in asystole.”

“What was his initial rhythm?” Kerry wanted to know.

“He’s been asystolic since he was pulled out of the river, but he had a pulse before that,” answered Carol. “I examined him in the van before it went over the side of the bridge. He’d lost consciousness, but he was breathing.”

Susan caught Carol’s eye and gave her a grateful smile. She could tell the nurse was clinging to that last shred of hope, hellbent on saving their patient, just like she was.

Kerry, on the other hand, seemed ready to call it quits. “And how long has it been since then?” she asked, panting slightly as she pumped his heart.

Carol glanced at the clock again. “Almost fifty minutes,” she admitted. “There’s something else I just thought of, though. When I listened to his chest in the van, I heard a murmur. I was worried he might have an aortic dissection.”

Susan’s eyes widened as she looked down at the patient, considering this possibility. He didn’t appear to have any genetic disorders or other obvious risk factors that would predispose him to such a catastrophic condition, but she supposed it could have been caused by blunt chest trauma or a deceleration injury he had sustained during the crash. “Let’s do a transesophageal echo and check for blood in the chest,” she decided, hoping to rule it out. If Brian’s cardiac arrest had been caused by a ruptured aorta rather than drowning, as they had assumed, then he was already dead.

“I’ll do it,” Mark volunteered, as Lydia raced to set up the ultrasound equipment. The resuscitation efforts continued as Mark inserted the probe into the patient’s esophagus, advancing it downward until it was positioned directly behind the heart. “I don’t see any free fluid in the chest cavity,” he said, squinting through his glasses at the ultrasound screen as he adjusted the angle of the probe. “Aorta’s intact - no sign of injury. The heart’s refilling with blood after each compression, but… it looks enlarged, doesn’t it?” He turned the screen toward Susan so she could see it, too.

She frowned as she studied the screen. “For a man his size? Yeah… it definitely does,” she agreed. “Could be some kind of underlying condition. Should we call for a cardiology consult?”

“Let’s focus on achieving ROSC first,” Mark advised her, pulling out the probe. “No point in wasting anyone’s time hurrying down here for a heart that’s not even beating. Even if he does have an underlying condition, I doubt it’s what caused him to arrest.”

“It could be a contributing factor…”

Mark raised his eyebrows, giving her a look that told her she was reaching. “Susan, he was underwater for, what, twenty minutes? This is a clear case of drowning.”

“But maybe we’re missing something,” Susan said stubbornly, her mind racing. She racked her brain, running through every possible cause she could come up with for refractory cardiac arrest. “Think Hs and Ts: besides hypoxia, hypothermia, and hypovolemia, what else could be keeping his heart from responding to the drugs?”

“Brain death?” suggested Kerry in a sarcastic tone. “Take a look at his pupils, Dr. Lewis. What do you see?”

With a sense of dread, Susan approached the head of the bed. Gently, she used her finger to lift one of the patient’s eyelids. His pupil was so large, she could barely see the blue iris surrounding it, and it didn’t shrink under the fluorescent lights. She knew this was a bad sign, but nevertheless, she pulled her penlight out of the front pocket of her lab coat and flicked it on, shining the narrow beam into the patient’s eye. She observed no response; his pupil remained in the same position. A repeat examination of the other eye revealed the exact same results. “Fixed and dilated,” she admitted, feeling defeated as she lowered the eyelid over his glassy stare.

“It’s time to face the facts. This boy has been dead since before his body was recovered from the water,” Kerry stated bluntly. “We’ve been trying to resuscitate him for over forty minutes now, and nothing has worked. How long are we going to delay the inevitable?”

Susan looked back through the window into Trauma 2, where she could see Kevin and Nick watching. Kevin’s hands were clasped tightly together, as if in prayer, while Nick was anxiously rocking back and forth. She didn’t want to let them down.

“This is my patient and my code. We’re gonna keep going until I say stop,” she snapped. “I promised those guys in there we wouldn’t give up, and I meant it. If you’re not here to help, then get the hell out!”

Kerry looked up, her icy blue eyes piercing Susan’s, and lifted her hands off the patient’s chest. “Fine. You wanna keep flogging him? Be my guest.” She retrieved her crutch, slipping her right arm into its cuff, and stepped back from the bed.

Susan brushed past her, practically pushing the crippled woman aside as she moved in to take over CPR. In the back of her mind, she knew Kerry was probably right about delaying the inevitable, but she wasn’t ready to pronounce his death just yet.

“What are you doing, Susan?” said a low voice after Kerry left. Susan looked up and saw Mark staring at her from the other side of the gurney.

“Trying to save my patient, Mark,” she replied evenly as she bent over the boy’s body. She could feel the muscles in her back and shoulders screaming in protest as her arms pistoned over his sternum, but she fought through the pain. “Got any ideas for me?”

“Pray?”

She glanced up again long enough to give Mark a disgruntled look. “I was thinking of something more scientifically-proven. Hey, what about cardiopulmonary bypass? Hasn’t that been shown to work in hypothermia cases?”

He shook his head. “That’s only recommended in patients with much lower core temps, as a way of rapidly rewarming them during resuscitation. He’s above the threshold.”

Susan sighed. “So you’re saying he’s already ‘warm and dead’?”

“Not until you pronounce him.” Mark shrugged. “It’s your call, Susan.”

Susan appreciated his confidence in her, but she could tell he was with Kerry on this one. He was just too polite to say so. “It wouldn’t hurt to try, though, would it?” she persisted. “I mean, at least it would keep his blood circulating better than CPR.”

“But for how long? You can’t leave him on bypass for more than a few hours. Eventually, you have to get his heart beating on its own, or he’s dead either way. Sorry, Susan, but I don’t see the point in putting a patient through an invasive procedure just to delay the inevitable.”

Susan frowned as she realized Mark was echoing Kerry’s earlier words. “Fine. Let’s try another amp of epi then. Lydia?”

“Coming right up,” the nurse replied, retrieving another vial from the cart.

As Lydia injected the drug into Brian’s IV line, Connie poked her head through the doorway connecting them to Trauma 2. “Susan? Radiology’s ready for Mr. Richardson now, but he’s not. He’s refusing to go... begging me to let him stay here with his cousin.”

Susan sighed. “Mark, will you take over compressions so I can go talk to him again, please?”

“Sure, Susan.” Mark may not have agreed with her course of treatment, but he complied with her request, continuing CPR while she went next door, where Kevin and Nick were still watching through the window.

“Kevin,” she said gently, “I know you want to be with Brian, but it’s really important that you get down to Radiology to have X-rays taken before the orthopedic surgeon gets here. If you don’t, it will only delay surgery.”

Kevin shook his head. “I don’t care about that right now,” he muttered without looking at her.

“An open fracture is nothing to mess around with,” she warned him. “The longer we wait to repair it, the higher your risk of complications, like bleeding, infection, or loss of circulation. In a worst-case scenario, we wouldn’t be able to salvage your leg and would have to amputate it below the knee.”

That got his attention - and Nick’s, too. “What?!” the kid cried, his blue eyes bugging out of his head. “No way! Kev, you can’t let it get that bad. Go get your X-rays. I’ll stay with Brian.”

Kevin sniffed and wiped his eyes. “Can you just give me a few more minutes with him? Maybe wheel me in there so I can…” He trailed off, pinching the bridge of his nose as he bowed his head.

Susan understood. He needed closure, a chance to see his cousin up close… touch him… talk to him… and tell him goodbye.

“Okay, but just for five minutes,” she conceded, bending down to unlock the wheels on his gurney.

Connie helped her roll Kevin into the next room, where the rhythm of resuscitation went on. Mark was panting as he pumped Brian’s chest, the gurney rattling beneath their combined weight. Lily was still squeezing the Ambu bag after every five compressions, forcing oxygen into Brian’s lungs. Lydia fiddled with the IV, making sure the medication was flowing into his veins to try and stimulate his heart, while Carol watched the minutes tick away on the clock. “Two minutes since the last epi,” she said quietly, as Connie and Susan parked Kevin’s bed next to Brian’s. Nick hung back in the corner, his arms crossed tightly over his chest as he watched with a look of terror on his tearstained face.

Time was running out. The longer they kept going without any kind of response, the less likely they were to have a good outcome. One more round, Susan told herself. If we can’t get a rhythm in the next five minutes, it’s over.

“Let’s pause for another pulse check,” said Mark breathlessly, straightening up. The back of his scrubs were soaked with sweat.

Seven pairs of eyes turned hopefully to the heart monitor, only to see the same stubbornly flat line continue straight across the screen.

“No pulse,” said Lydia, as she pressed her fingers against the carotid artery in Brian’s neck.

“Still asystole,” sighed Mark, turning to Susan. Time to call it, his eyes were telling her.

Rationally, she knew he was right. The situation seemed hopeless. There was no sign of electrical activity in her patient’s heart; there hadn’t been the entire time they had been working on him. The kid had been clinically dead for close to an hour now, and despite their heroic measures, her team couldn’t bring him back to life. But behind Mark, she could see Kevin and Nick both watching her, and their eyes were begging her to keep trying.

Susan cleared her throat. “Carol, will you take over compressions, please?” she said, prompting the nurse to trade places with Mark. “Lydia, give him one more amp of atropine.”

“Got it,” said Lydia, fetching another vial from the crash cart.

“Can’t you shock him or something?” Kevin asked desperately, as Carol went back to pushing on Brian’s chest, just as she had in the beginning.

Susan shook her head. “A defibrillator only works for certain rhythms. Unfortunately, Brian doesn’t have a rhythm to shock,” she explained as delicately as she could. “We’ve been giving him medications to try to restart his heart, but they haven’t helped. At this point, he’s probably beyond help.”

“No… please,” Kevin pleaded hoarsely, as tears poured from his eyes.

“You can talk to him,” she encouraged. “Let him know you’re here… that he’s not alone.”

Kevin nodded. Clearing his throat, he muttered, “Brian, it’s me, Kev. If you can hear me right now, you gotta hang on, okay? C’mon, cous… come on back to us.”

“Please, Frick,” Nick begged, rocking back and forth on the balls of his feet. “Please come back.”

“Atropine is in,” Lydia announced as she pushed down the plunger of the syringe she had plugged into Brian’s IV line.

Better pray it works, thought Susan, swallowing hard. Religion had never played a big role in her life; she preferred to put her faith in science. But if there was ever a time to pray for a miracle, it was now.

The room went quiet as they continued CPR, forcing the medication to circulate through Brian’s system. By now, the nurses just seemed to be going through the motions, pumping his chest and squeezing the Ambu bag with the kind of automaticity that came with experience. Susan could tell none of them truly believed they were going to get their patient back at this point.

She tried her best to prepare the two boys. “We’re going to give the medicine a couple minutes to kick in,” she told Nick and Kevin, “but if it doesn’t work… we’re going to have to let Brian go. He’s been down too long. Do you understand?”

This time, neither one of them protested. Kevin nodded, tears dripping from his chin. Nick said nothing, just stood there hugging himself as his whole body trembled. It seemed that seeing their friend up close had helped the harsh reality of the situation hit home. Based on Brian’s gray pallor, it looked like he was already gone.

“It’s been two minutes,” said Mark, glancing at the clock. “Hold compressions.”

Carol’s hands hovered above Brian’s chest, as they all looked up at the heart monitor again. But this time, Susan noticed a slight variation in the formerly flat line. It was a subtle rise and fall, not very tall and far from anything resembling an organized rhythm - but electrical activity nonetheless, the first sign of life he had shown since being brought in. “That looks like fine V-fib to me,” she gasped, barely able to believe what she was seeing. “Resume compressions. Charge the paddles to two hundred.”

“Charging,” said Lydia, as she fired up the defibrillator on top of the crash cart.

“Stay back. Don’t touch him,” Susan told the two boys, making sure they were a safe distance away from Brian’s bed before she picked up the paddles. She rubbed them together to distribute the liberal amount of conductive gel Lydia had applied.

“Charged to two hundred,” the nurse announced.

“Clear!” Once everyone around the bed had held up their hands, Susan pressed the paddles to Brian’s chest and pushed the button to discharge them. His torso twitched as an electric current zapped across his heart. The line on the cardiac monitor spiked sharply, then bottomed out before reverting back to the same random squiggle as before. “No response,” said Susan, watching the frenetic waves of ventricular fibrillation scribble across the screen. She thought their amplitude looked a little higher, at least. “Continue CPR, and let’s hit him again - three hundred this time.”

“Charged to three hundred.”

“Clear!” Again, Susan applied the paddles, and Brian’s body jerked with the sudden jolt of electricity that surged through it. Again, the rhythm on the monitor remained chaotic, incompatible with life. “Still in V-fib. Crank it up to three-sixty.”

“C’mon, cous…” she could hear Kevin chanting in the background.

“Charged to three-sixty.”

Third time’s the charm, Susan thought hopefully as she raised the paddles once more. “Clear!” Carol halted her compressions. Lily let go of the Ambu bag. Susan lowered the paddles onto Brian’s chest, pushing down firmly as she defibrillated him. His whole body seemed to jump beneath her hands… and then, miraculously, his heart began to beat.

Susan could hardly believe her eyes when she looked up at the monitor and watched the waveform change, the random peaks transforming into a recognizable pattern of P-waves and QRS complexes. “We’ve got a rhythm!” she gasped, her own heart bounding inside her chest. She held her breath as she studied the screen. The green line crept across it, continuing to rise and fall in a series of slow, but steady beats. “Looks like sinus bradycardia. Anyone feel a pulse?”

Lily pressed her fingers to the side of Brian’s neck. “He’s got a faint carotid pulse.”

“Weak radial pulse is present, too,” Lydia confirmed, raising her eyebrows as she palpated the artery inside his wrist.

Susan exhaled a sigh of relief. “Okay,” she said, her mind racing as she tried to gather her thoughts. “We have a perfusing rhythm, so we’ve achieved ROSC. Great job, everyone. Lydia, let’s give him one more milligram of atropine to see if we can get his heart beating a little faster. We don’t want him to start bradying down again. Lily, keep bagging him until we can call for a vent. Carol, can you get a BP?”

As her team buzzed around Brian’s bed, carrying out her orders, Susan turned to his two friends. “Thank you, Dr. Lewis… Susan,” said Kevin, as tears streamed down his face. “Thank you so much for saving him.”

Susan flashed him a grim smile. “Brian’s not out of the woods yet,” she warned him. “We still need to stabilize him and run some tests to determine how much damage was done. His heart’s beating again, but his brain was deprived of oxygen for a long time while he was underwater. We don’t know what kind of condition he’ll be in when he wakes up. If he wakes up.”

“But he’s alive,” Kevin murmured, smiling back through his tears. “That’s all that matters right now.” Behind him, Nick was nodding, his body still trembling beneath the blanket draped around his shoulders.

Susan nodded, too, but in the back of her mind, she couldn’t help but think, Sure, he’s alive… unless he’s brain dead. Had she actually saved his life, she wondered, or only prolonged his death? She wouldn’t know until the test results came back. Even if he did turn out to have some brain activity, it could take days or weeks to get a clear picture of his prognosis. He might regain consciousness and make a miraculous recovery, but in reality, it was more likely he would remain comatose or in a persistent vegetative state. All they could do now was stabilize him here in the ER and admit him to the ICU, where they would take a “wait and see” approach.

In the midst of the post-resuscitation rush, Chuny came bursting into the trauma room. “Mark!” the nurse cried. “They need you in CT; your patient’s crashing!”

Mark heaved a sigh as he stripped off his gloves. “Great,” he groaned, running a hand over his receding hairline. “I’ll be right behind you, Chuny.” But before he hurried out after her, he turned back to Susan and smiled. “Nice save, Susan.”

“Thanks. Good luck!” she called, as he raced on to resuscitate the next patient.

Connie raised her eyebrows at Susan. “Can I take Mr. Richardson to Radiology now?”

“Yes - please! And no ifs, ands, or buts about it,” she added sternly to Kevin, who consented with a nod.

“Thanks again for taking such great care of me and my cousin,” he told her, as Connie rolled his gurney out of the room.

“Just doing my job,” Susan replied with a shrug, though she felt a smile tugging at the corners of her lips. She turned back to Brian, who was looking a little better. Some color had come back into his ashen complexion. “Can I get a set of vitals?” she asked the nurses.

“He’s back in normal sinus rhythm - heart rate sixty-two. Slightly hypotensive with a BP of eighty-five over fifty. Sats are at ninety-eight percent, and his core temp is up to ninety-five degrees,” Carol reported.

Susan nodded, satisfied with those numbers for now. “Good.” She slipped her stethoscope into her ears and bent over Brian’s chest to listen. His heart was beating steadily, though she noticed the faint murmur Carol had mentioned auscultating earlier, an abnormal whooshing noise that accompanied each contraction. She was more concerned about the water in his lungs; she could hear wet crackles as they filled with air from the Ambu bag that was forcing him to breathe. “Call Respiratory to bring a ventilator and then Radiology for chest films. I want a C-spine and head CT, too,” she told Carol.

Then she moved to the head of the bed, lifting Brian’s eyelids to check his pupils again. They both looked slightly less dilated than the last time she had checked, but they still didn’t contract when she shone her penlight into his eyes. It wasn’t a positive sign, but she hoped they would become more reactive with time.

Satisfied that he was stable for now, she turned back to his friend Nick. “Would you like to come closer?” she started to ask, but the words stalled on her tongue when she saw how white his face had become, beads of sweat glistening on his forehead. “Nick, are you o-?”

Before she could finish her second question, the boy’s knees buckled, his body slumping toward the floor in a dead faint. Susan dove and managed to catch him, or at least cushion his fall before his head hit the hard tile. “A little help here!” she called, as she lowered his upper body down until he was lying flat.

“Oh my god - Nick!” cried Carol, her eyes widening as she hung up the phone. “What happened??”

“I don’t know; he just collapsed.” Susan reached for her stethoscope again and slid it down the front of Nick’s damp t-shirt. She was relieved to hear both heart and breath sounds, though both gave her cause for concern. “He’s diaphoretic with rapid, shallow resps, and his heart’s racing. He could be in shock.”

Carol had dropped to her knees next to Nick, a blood pressure cuff in her hand. She wrapped it quickly around the boy’s upper arm and inflated it, auscultating his brachial artery with her stethoscope as she slowly let the air out. “He’s barely registering a BP,” she said in alarm.

“His pulse is weak and thready,” Susan replied as she palpated his carotid artery, feeling a faint flutter beneath her fingertips. “Find Ross. Tell him we’ve got a crashing kid in here and need his help right now!”

***

 

Chapter 6

Dr. Doug Ross had a reputation around County General. As a pediatrician, he was widely respected for his both clinical skills and his bedside manner, but as a person, he received mixed reviews. He had been referred to as a cowboy, a rebel, and a rogue by his male colleagues, while the female ones tended to call him a womanizer, a philanderer, and a flirt. He found it hard to separate his personal life from his professional practice, especially when he always seemed to be surrounded by attractive women at work. Diane from Risk Management… Linda, the drug sales rep… Holda, the sexy Scandinavian stewardess who had been a patient… and of course, Carol. Beautiful, curly-haired Carol.

His shadow that morning, third-year medical student Harper Tracy, was no exception. With her blonde hair, sparkling brown eyes, and perky breasts, she could have been on the cover of magazines. Instead, she was bent over a teenage boy’s penis, inserting a Foley catheter into his bladder.

“Let me know if you feel any pain, AJ,” Harper told the patient as she finished prepping for the procedure by covering the tip of the catheter in lubricant. “This may feel a little uncomfortable, but it shouldn’t hurt.”

“I can’t feel anything down there anyway,” AJ muttered bitterly. He lay flat on his back, fully immobilized by the rigid cervical collar around his neck and the hard spinal board to which his body had been strapped. The poor kid couldn’t even reach up to wipe away the tears that were streaming down his bright red cheeks.

Doug felt for him. After all, he had been seventeen once - self-conscious, girl-crazy, and seemingly invincible, an adolescent on the cusp of adulthood with his whole future ahead of him. This boy’s world had just been turned upside down, his future plans put in jeopardy, his life possibly changed forever… and if that wasn’t bad enough, he now had to lie there helplessly while this total babe of a med student stuck a tube up his dick. Doug would have been embarrassed, too. But it was necessary - the boy had lost control of his bladder, as evidenced by the urine-soaked clothing they had cut off of him earlier, and claimed he couldn’t feel anything below the waist.

“We’re gonna run some tests to figure out why you can’t feel anything and see if we can fix it,” Doug tried to assure him, blotting his face with a tissue. He remained by the head of the bed while his nurse, Haleh, coached Harper through the procedure. It had been years since Doug had put in a Foley himself; typically, that was something the nurses did. Haleh Adams was one of the most experienced nurses they had working in the ER.

“Now, advance the tip into the meatus,” she was telling Harper, who, despite her looks, was no dumb blonde. In the first few weeks of her ER rotation, Harper had proven herself to be highly capable, a fast and eager learner. “Good,” Haleh praised her. “Keep pushing it in gently, about an inch at a time. There you go. If you meet any resistance, just rotate it slowly right and left until the tissues relax enough to let it pass; don’t try to force it.”

More tears spilled out of AJ’s eyes as he stared miserably at the ceiling. “I know this sucks, kiddo,” Doug said, ruffling his dark hair. “Not the way you wanted to spend the morning, huh? But hey, look on the bright side: I bet this buys you at least a few days off school. Is that where you were headed - school?”

AJ sniffled. “No. I’m not really in school right now; I have a tutor who travels with me instead. I’m part of a band. We’ve been performing all over the country for the past couple years.”

“Really?” replied Doug, raising his eyebrows. “Wow… so you’re already living like a rockstar, out on the road. And to think, when I was seventeen, I was schlepping burgers after school.” He grinned.

A ghost of a smile flickered across AJ’s face. “Eh, it’s not as glamorous as it sounds. Our van’s a piece of shit, and we have to share hotel rooms. There’s five of us in the group, so someone always gets stuck sleeping on the floor - usually me or Nick cause we’re the youngest.” For a few seconds, it seemed like talking about his band had taken his mind off of what had happened to him, but all of a sudden, his expression changed, his brow creasing with worry again. “God, I hope Nick and the other guys are gonna be okay…”

“What’s the name of your band?” Doug asked, trying to distract him again.

“The Backstreet Boys. You probably haven’t heard of us, have you?” AJ looked up at him hopefully, but Doug shook his head.

“Sorry, can’t say that I have. What kind of music do you do?”

“Pop and R&B. It’s okay; we haven’t really hit it big yet. We just got a record deal last year. We’ve mostly performed at schools, malls, theme parks, places like that, but right now we’re doing a radio tour to promote our first single we just released.”

Doug raised his eyebrows again, impressed that he had a bona fide recording artist in front of him, even if it was one he’d never heard of. “Yeah? Well, congratulations on the record deal. What’s your song called?”

“‘We’ve Got It Goin’ On.’”

He nodded, cracking a smile. “I bet you do.”

“Wait a second…” At the foot of the bed, Harper suddenly looked up. She had been quiet during their conversation, focusing on her procedure, but apparently she had been listening. “Is that the song that starts ‘Everybody, groove to the music. Everybody jam…’?”

Doug and Haleh both looked at the med student in surprise as she started singing, one hand still firmly grasping the patient’s penis while the other threaded the catheter through his urethra.

AJ’s eyes widened. “Yeah!” he gasped. “That’s it!”

“I’ve heard that song at the club at least a couple of times!” Harper exclaimed. “That’s you?!” She suddenly looked down, the smile fading from her face when she remembered what she was in the middle of doing to the seventeen-year-old singer. Her cheeks turned bright pink, as if she had suddenly realized she might have said too much.

AJ was blushing furiously, too, but he answered, “Yeah… that’s me and the Boys.”

“Wow… well, it’s a great song. Really catchy,” replied Harper before she bent over again and got back to work. Watching with amusement, Doug and Haleh exchanged a grin. The poor girl was clearly flustered, but she finished the procedure without any complications. “I’ve got some urine return,” she told Haleh, showing her the amber-colored fluid flowing through the tube. Doug was relieved to see that it looked clear - no sign of blood, which could indicate internal injuries.

“Good. That means you’re in,” said Haleh, nodding with satisfaction as she inspected the site. “Use the syringe to inflate the balloon with ten CCs of sterile water.” Once the catheter was in place, she showed Harper how to secure the tubing to the patient’s leg and hang the collection bag on the side of the bed.

Doug cleared his throat. “Now that that’s taken care of, kiddo, we’re gonna do a test to assess your level of feeling and function in different parts of your body. This will help us figure out exactly where you’re hurt and how to help you. Okay?”

“Okay,” AJ said, sounding nervous. “Can my mom come back in yet?”

“Eh, it’s probably best she stays in the hall until after this test,” answered Doug, who’d had Haleh escort the hysterical Mrs. McLean to chairs before they put in the Foley. No teenage boy wanted his mom around to witness that particular procedure, just as no doctor preferred to have his patient’s family members present during an ASIA Exam. It was too hard to watch - and too tempting not to cheat. “You look like a tough guy. You’ve got this, right?”

AJ put on a brave face, but Doug could see the fear in his dark brown eyes.

The pediatrician turned to Harper. “Ever seen an ASIA Exam done before?” he asked her. ASIA stood for the American Spinal Injury Association, which had developed the standards for assessing spinal cord damage.

The med student shook her head. “Not on a real patient. Just practice ones in class.”

“No problem. Mark thought this would be a good opportunity for you to observe one. Watch me and record the findings on this form,” Doug replied, handing her a clipboard with a diagram of the body, divided into key sensory points and labeled with the spinal nerve that controlled each part of it. By documenting the sensation and motor function the patient had in each area, they could classify the level and type of injury.

“Sounds good,” Harper said with confidence, taking a pen out of the pocket of her lab coat.

Doug pulled a cotton swab out of a container on the counter and showed it to their patient, explaining, “All I’m gonna do for this first part of the test is touch you in a few different places with a cotton swab and have you tell me if it feels normal or not normal. This is what it should feel like.” He brushed the tip of the cotton swab across the boy’s forehead, an area where he should have normal sensation. “Do you feel that?”

“Yeah.”

“Good. Okay, AJ, I’m gonna have you close your eyes now, and when you feel me touching you with the cotton swab, tell me if it feels normal or not normal. Got it?”

“Got it,” AJ muttered, closing his eyes.

Doug dragged the cotton swab lightly down the side of his face. “C2,” he muttered to Harper, making sure she was looking at the right part of the chart.

“Normal,” said AJ, as expected. If his spinal cord had been injured at that level, he would have been intubated by now, unable to control the muscles in his chest he needed to take a breath. Luckily, his breathing had been normal during Doug’s initial examination.

Doug moved the swab to a spot just above his collarbone. “C3.”

“Normal,” AJ said again.

Doug continued across to his shoulder and then down his right arm to the tips of his fingers. He repeated the same procedure on the left arm. The sensation was normal on both sides, which meant the patient’s cervical nerves were intact. Doug worked his way down the boy’s chest, assessing his thoracic nerves. All was well until he neared AJ’s waist level, at which point the sensation became “not normal” and then absent altogether below the waist.

“Are you still touching me?” asked AJ, frowning, as Doug brushed the cotton swab across the sole of his left foot.

The doctor cleared his throat. “Nope, all done for right now,” he replied. “You can open your eyes.”

AJ looked up at him uncertainly. “How’d I do?”

“You did just as I asked,” said Doug, smiling down at him. “Now, for the next part of the test, I’m going to see if you can feel the difference between a sharp touch and a dull touch. The sharp touch will be a light prick with the pointy end of a safety pin. It’ll feel like this.” Gently, he poked AJ’s forehead with the pin. “The dull touch will be the round end of the safety pin.” He flipped the safety pin around and rubbed the curved bend across AJ’s brow. “Can you tell the difference?”

“Yeah.”

“Good. I’m gonna have you close your eyes again, and this time, I want you to tell me if the touch you feel is sharp or dull. Got it?”

“Got it.”

The pediatrician repeated the procedure, this time alternating between the two ends of the safety pin as he probed each area. The results were what he had expected: AJ had normal sensation above the waist, where he was able to tell the difference between the two types of touches, but below the waist, he couldn’t feel a thing.

Next, Doug unfastened the straps from the spinal board to free AJ’s limbs so he could assess his motor function by asking him to move different muscles or resist when the doctor tried to manipulate his limbs. While AJ had full strength and range of motion in his arms, hands, and fingers, his legs were dead weight in Doug’s hands, limp and lifeless. He couldn’t lift them off the bed, nor prevent Doug from pushing them back down. It broke Doug’s heart to hear him ask, “Am I doing it?” when Doug told him to wiggle his toes. Lying flat on his back, AJ couldn’t even see his feet to tell whether or not they were following the commands his brain was giving them.

“You’re doing great,” Doug assured him, dodging the question. He would wait for the neurology consult he had called to come down and examine AJ before giving him any kind of prognosis. Doug was no neurologist, but based on the findings, he suspected his patient had suffered a spinal cord injury somewhere around the junction between the thoracic and lumbar vertebrae in his lower back. If it was a complete injury, the boy would be a paraplegic - paralyzed from the waist down and likely to be wheelchair-bound for the rest of his life. He didn’t want to be the one to break that kind of devastating news to a seventeen-year-old kid with dreams of stardom.

“Did you get all that down?” he asked Harper quietly, craning his neck to check her notes. She nodded, giving Doug a grim look as she showed him the clipboard she had used to record AJ’s test results. She, too, seemed to understand the implications of what they revealed. Her eyes had lost some of their sparkle; he could see the expression of pity reflected in them as they glanced back at the patient.

“Hey, Doc, you didn’t answer my question,” said AJ, his own eyes flashing accusingly as they shifted to Doug’s face. “Did my toes wiggle or not?”

Doug sighed. “No,” he admitted. “They didn’t.”

“Damn,” AJ groaned, his face crumpling. “Does this mean I’m gonna be a cripple?” Fresh tears filled his eyes as he looked desperately at Doug.

“Not necessarily,” Doug tried to reassure him. “I don’t want you to worry yet. The paralysis may not be permanent. There’s one more part to this test that will tell us whether your injury is complete or incomplete. If it’s incomplete, there’s a better chance you could recover at least some feeling and function below the waist.”

Through the tears, the pediatrician saw a glimmer of hope in his patient’s eye.

Clearing his throat, he went on, “I’ve gotta warn you, though, this part’s not real pleasant. We’re gonna roll you onto your side so I can give you a quick rectal exam.”

AJ snorted, apparently assuming he was joking. When Doug didn’t crack a smile, the kid’s eyes widened. “Wait, you’re gonna what?! Seriously?”

“Seriously. Trust me, it’s not my favorite thing to do either,” he said apologetically, “but it’s necessary. We need to check for something called ‘sacral sparing.’ This test will tell us if any signals sent by your brain are making it all the way to the bottom of your spinal cord, which controls the area around your anus.”

AJ made a face.

“The good news,” Doug continued, “is that we’ll have to get rid of that backboard you’re lying on, so you should be a little more comfortable when this is all done. Okay?”

The kid closed his eyes and sighed. “Do whatever you gotta do, I guess.”

Doug turned to Harper and Haleh, telling them, “Let’s log roll him onto his left side and remove the spinal board.” Working together, the three of them moved AJ’s body into the proper position, taking care to keep his spine in alignment.

“Okay, AJ, I want you to tell me when you feel a sharp or dull touch, just like before,” said Doug, taking out his trusty safety pin again as he sat down on a stool behind his patient. He poked AJ in a few places with both the curved and the pointed side of the pin, but there was no response from the boy.

Knowing he needed to go deeper, Doug snapped on a fresh pair of gloves. “Doing great, kiddo,” he said, as he dipped his index finger into a liberal amount of lubricant. “I’m going to put my gloved finger inside you now, okay? You may feel a little bit of pressure, but you shouldn’t feel any pain.”

“Just get it over with,” AJ groaned.

Carefully, Doug inserted his finger a couple of centimeters. “Can you feel anything?” he asked, as he slowly rotated it clockwise.

“Yeah!” AJ gasped. “Pressure… like you said.”

Doug caught Harper’s eye. Her brows were high on her forehead in a hopeful expression as she observed the exam. “Can you tell which side I’m pushing on?”

“Um… the right?”

“That’s right,” said Doug, shooting Harper a grin. “Very good.” The student offered a relieved smile in return. “Okay, one last thing - I want you to squeeze your sphincter like you’re holding in a bowel movement. Can you do that for me?”

“I’ll try…” AJ said, sounding both doubtful and disgusted by what he had been asked to do. But a few seconds later, Doug felt the muscles tighten around his finger.

“There you go!” he praised his patient. “That’s it!”

“I did it?” asked AJ in disbelief.

“You did it,” Doug confirmed, removing his finger. “You did very well.” He stood up, stripping off his gloves, and went to the sink to wash his hands.

“Good job, honey,” he could hear Haleh reassuring AJ in the background.

When he returned to the bedside, Harper and Haleh helped him roll AJ onto his back again. “So,” said Doug, smiling down at the teenager. “What that test told us is that some signals are still getting through, so the injury to your spinal cord is incomplete. That makes your odds of recovery much higher.”

“So I’ll be able to walk again?” asked AJ hopefully.

Doug hesitated, feeling his smile fade. “I can’t promise that. I’ve called another doctor, one who specializes in spinal cord injuries, to come take a look at you. He’ll be able to give you a better idea of what to expect after he’s had a chance to examine you and do some more tests.”

Suddenly, the door to the exam room burst open. Doug turned his head, surprised to see Carol - beautiful, curly-haired Carol Hathaway - hurrying in. “Doug, I need you!” she cried. “We’ve got a kid crashing in Trauma 1!”

Doug’s heart leapt into his throat, racing with a surge of adrenaline. “Hang out here until Radiology’s ready for him,” he told Haleh. “Harper, bring his mom back to the room and then meet me in Trauma 1.” Then he took off after Carol, watching the way her black curls bounced about her shoulders as she jogged through the hallway.

“Where did they take Nick?” she asked Lydia, who was tending to the patient in Trauma 1 - apparently not the same one she had summoned him for.

“Next door,” the nurse replied, pointing to Trauma 2.

Doug and Carol barrelled through the door that connected the two trauma rooms. Susan Lewis was bent over the teenage boy lying on the bed, examining him while one of the nurses, Lily, started an IV.

“His name’s Nick,” Carol said shakily, as she and Doug hurried over to help. “He was a backseat passenger in that van accident on the bridge. I examined him at the scene; he was alert and oriented with normal vitals and no obvious injuries or complaints, but he just collapsed without warning a few minutes ago while he was watching us work on his friend. I must have missed something...”

“You don’t know that,” said Doug, who was naturally inclined to come to Carol’s defense. They had dated a couple of years earlier, but he had ruined that relationship the same way he seemed to ruin all his relationships. At least Carol didn’t seem to be hurting anymore; the last he’d heard, she had started seeing a paramedic. That was probably why she had been at the accident scene in the first place, he realized: she’d been riding in his ambulance. “He could have just fainted from emotional trauma,” Doug added, forcing himself to forget the paramedic and focus on the patient. His eyes swept over the unconscious kid, noting his pale and diaphoretic skin. “What are his vitals?”

“BP seventy over forty, heart rate one ten, resps twenty-five and shallow,” said Susan, taking her stethoscope out of her ears.

Doug frowned. “On second thought, it sounds more like he’s in shock. He could be bleeding internally. Carol, call Radiology - he needs a head, chest, and abdominal CT, stat. Lily, run in a liter of normal saline, and let’s get a full trauma panel: CBC, lytes, BUN and creatinine, lactate, urinalysis, blood gas, and type and cross.”

“His belly looks distended, Doug,” Susan pointed out, as she peeled the cut flaps of damp fabric from Nick’s oversized t-shirt away from his skin.

Doug noticed a characteristic abrasion across his abdomen, just below the naval. “He’s got a seatbelt sign,” he added, suspecting an intra-abdominal injury.

Replacing her stethoscope, Susan pressed the diaphragm to the upper left quadrant of his abdomen and listened. “Decreased bowel sounds,” she observed, as she slid the stethoscope lower.

Doug snapped on a pair of gloves before he began palpating the boy’s abdomen. It was tight and firm, with a doughy fullness that further supported his diagnosis. “Belly’s rigid. Let’s do a portable ultrasound.” It was the fastest way to confirm the presence of blood or other fluid in the abdomen, besides the more invasive peritoneal lavage.

“I’ll grab the cart from next door,” Susan volunteered, slipping back into Trauma 1.

As Doug continued his examination, pushing his fingers down deeper, the patient started to regain consciousness. Doug felt the boy’s abdominal muscles tense as he moaned and tried to twist away from the doctor’s hands. “Rebound pain and guarding are present.”

Carol hung up the phone and rushed to his bedside. “Hi, Nick,” she said softly, stroking the boy’s blond hair back off his sweaty forehead. “You fainted a few minutes ago in Brian’s room. How are you feeling?”

Nick’s eyelids fluttered. “My stomach hurts,” he mumbled, barely audible.

“I know. Dr. Lewis and Dr. Ross here are going to find out why and get you feeling better.”

Doug cleared his throat. “Actually, I think we’re gonna need a surgical consult for that. Anyone seen Benton around?”

“I’ll page him,” Carol offered, picking up the phone again.

Doug took her place at the head of Nick’s bed. “I’m Dr. Ross,” he said, smiling down at him. “We’re gonna give you some medicine to help with the pain, okay? Lily, let’s start with three of morphine.” As the nurse injected the medication into Nick’s IV, Doug asked his patient, “Does it hurt anywhere else besides your belly?”

“No…” Nick looked up anxiously as Susan came back in with the portable ultrasound equipment, which she set up next to his bed. “Is Brian okay?” he asked her.

She flashed him a tight-lipped smile and nodded. “He’s hanging in there.”

“Good…” Upon hearing that, Nick seemed to relax a little, his eyelids drooping as he started to drift off again.

Doug cleared his throat. “Hey, Nick?” he said sharply, causing the boy’s blue eyes to snap back open wide. “Stay with us, buddy.” He wanted to keep the kid conscious and alert, concerned he was on the verge of crashing again. “So, listen: I can tell you were wearing your seatbelt, which was smart - it may have saved your life,” he added, offering his patient another reassuring smile. “But it also might have done some damage. We think you may be bleeding inside your belly, so I’m gonna take some pictures with my magic wand here and see what’s going on in there.” He picked up the ultrasound probe so the kid could see it. “This may feel a little cold.”

Nick flinched as Susan squirted some conductive gel onto his bare skin. Doug tried his best to be gentle as he moved the probe over the boy’s abdomen, applying just enough pressure to get a good picture on the ultrasound monitor.

“He’s got free fluid in the left upper quadrant,” Doug observed, frowning as he pointed out the collection of dark liquid - blood, most likely - filling the space in between the abdominal organs, which appeared white on a normal ultrasound.

“Have you called for a surgical consult?” Susan wanted to know.

“I paged Benton a few minutes ago,” said Carol. “Want me to page him again?”

Before Doug could answer, he saw Harper come in. “Hey, Harper, have you seen Dr. Benton around here?” he asked her.

“He and Carter are with a patient in Exam 2,” the med student replied.

“Good. I want you to go get him; tell him we have a hemodynamically unstable pediatric surgical patient who needs his help right now.” As Harper hurried off to fetch the surgical resident assigned to the ER, Doug turned back to the rest of the team. “In the meantime, let’s transfuse him, try to keep his pressure from bottoming out. Carol, hang four units of O-neg on the rapid infuser.”

While Carol set up for the blood transfusion, Doug took Nick’s hand and gave it a squeeze. “How you doing, kiddo?”

Nick shook his head. “I don’t feel good,” he whispered.

“I know. We’re gonna give you some blood and get you feeling better while we wait for another doctor to come check you out. You hang in there, okay?”

Nick nodded. “Do you know if AJ and Howie are okay?” he asked after a few seconds.

“Well, I haven’t seen a Howie yet, but I just came from AJ’s room,” replied Doug with a grin. “He was telling me all about the group you guys are in.”

“The Backstreet Boys, right?” Susan chimed in. “Kevin told me, too.”

A smile tugged at the corners of Nick’s colorless lips. “Yeah. So AJ’s okay?”

“He’s hurt, but I think he will be,” Doug answered guardedly. He didn’t want to give the kid too much information, but he also didn’t want to give him false hope that his friend would be just fine. AJ’s injuries didn’t appear to be life-threatening, but they could very well be life-altering.

“What about Denise?” Nick wondered. “That’s AJ’s mom.”

“She’s fine. She’s in with him now.”

“And Lou?”

“Lou? Not sure about him,” said Doug, but he saw Susan shake her head a fraction of an inch, a grim look on her face, and he knew: Lou was dead. Better to wait awhile before breaking the bad news, he decided, his eyes darting from Nick’s face to the monitor beside his bed. The kid’s blood pressure was still dangerously low. In his already precarious condition, the last thing he needed was to hear something that might send him over the edge. Instead, Doug tried to change the subject. “So, Nick… you like sports?”

“Yeah… basketball… and football…” Nick’s eyelids fluttered as the light faded from his blue eyes.

“Basketball, huh?” Doug said loudly, bearing down on his hand until the kid blinked, the cloudy look clearing. “Me too. Bulls fan?”

“Sure,” said Nick, a faint smile crossing his face. “Jordan and Pippen are the best.”

“You bet they are,” Doug agreed, grinning back. But behind his easygoing smile, he was worried, wondering, Where the hell is Benton?

***

 

Chapter 7

Dr. Peter Benton, third-year surgical resident, was both respected and feared by his colleagues at County General. Talented, ambitious, and hard-working, he took his career seriously - perhaps a bit too seriously. His job was important, no doubt; whether he was in the emergency room or the operating room, he often dealt with matters of life and death. But despite the demands of their work, the other doctors managed to laugh or at least smile once in a while. John Carter wished Benton would lighten up just a little. It would make working under him so much more pleasant.

John - or just “Carter,” as he had come to be called - had been assigned to Dr. Benton for his first clinical rotation of medical school in the County General ER. Now a fourth-year med student, Carter was back at County and working with Benton once again as he completed his highly-coveted surgical sub-internship. He’d gotten off to a rough start this rotation, but after surviving a disastrous first day, during which he had arrived two hours late and fainted in the middle of a trauma, he finally felt like he was back on track. It was hard to tell with Benton, who wasn’t big on giving feedback. Carter had come to accept the fact that he would never get accolades from his mentor. Anytime he made it through a full day without getting chewed out for one mistake or another, he considered it an accomplishment.

Carter was off to a good start that day. He had made it to the hospital on time for morning rounds and answered most of his resident’s questions right for once. Having just helped rule out a ruptured appendix in a woman with acute abdominal pain (correct diagnosis: a bad case of constipation), he and Benton were about to head back upstairs to the OR when they heard a voice shouting, “Dr. Benton, wait!”

Both men turned around to see Harper Tracy running up the hallway toward them. Carter couldn’t help but smile at the sight of the pretty blonde med student, whom he’d had a crush on ever since he had met her on her first day at County.

“Dr. Benton,” Harper said breathlessly. “Dr. Ross needs you in Trauma 2 right now for an unstable kid.”

“We’re on our way,” replied Benton without hesitation. “C’mon, Carter.”

Carter couldn’t believe his good luck. First he had gotten out of having to disimpact the constipated patient - which was exactly the kind of procedure Benton would have expected him to do during his ER rotation - and now, he was on his way to what promised to be a more interesting case. His heart bounded in his chest as he and Benton hurried after Harper to the trauma room, where doctors Ross and Lewis were hovered over a teenage boy with blond hair.

Nurse Carol Hathaway quickly brought them up to speed. “Nick Carter, fifteen, restrained backseat passenger in the MVA on the bridge. He was stable at the scene - no visible injuries, complaints, or LOC - but he collapsed and lost consciousness about an hour after he was brought in.”

Ross joined them in the corner of the room. “He’s showing all the signs of hypovolemic shock secondary to an abdominal bleed,” he said in hushed tones, so the kid couldn’t hear him. “He’s tachy and hypotensive, and his belly’s distended and tender with rebound pain and guarding upon examination. Labs aren’t back yet, but bedside ultrasound showed free fluid in the abdomen.”

Benton nodded. “Sounds like you’ve already made a diagnosis.” Nevertheless, he pulled on a pair of gloves as he approached the bed to examine the patient himself. “Hi, I’m Dr. Benton,” he introduced himself briefly before he began poking and prodding at the boy’s belly.

Carter hadn’t realized the patient was conscious, but when he heard the poor kid cry out, he hurried to the head of the bed. “Hi,” he said, giving the boy a sympathetic smile as he bent over him. “Your last name’s Carter?”

The boy nodded, his blue eyes appearing bleary and unfocused behind the fog of pain.

“What a coincidence - mine, too!” He gestured to the blue name badge pinned above the breast pocket of his white coat. “John Carter.”

A weak smile crossed the kid’s pale face. “Nick.”

Carter nodded. “Nice to meet you, Nick,” he said with a grin. “We’re gonna take great care of you.”

“You’re right; he’s gonna need surgery,” he heard Benton tell Ross. “Notify the OR; tell them to book a room for an emergency ex-lap.”

“Surgery?” Nick repeated, his eyes widening. “Right now?”

Carter nodded again. “The accident caused some bleeding inside your belly. We need to repair it before it gets worse. Unfortunately, that requires an operation called a laparotomy,” he explained. “I know that sounds scary, but you’re in good hands. Dr. Benton here is one of our best surgeons. He’s gonna fix you right up and get you feeling better.”

“Where are the parents?” Benton wanted to know.

“Nick, honey, is your family here in Chicago?” asked Carol.

Nick shook his head, tears welling in his eyes. “They’re back home in Tampa with my little brother and sisters,” he replied miserably.

“Who’s responsible for you when you’re out on the road?”

“I dunno… I guess Denise? AJ’s mom.”

“Denise McLean?” asked Dr. Ross, as he hung up the phone. Nick nodded. “She’s the mother of my other patient,” the pediatrician told the others. “I’ll go talk to her and see if she can help us reach his folks.”

Upon hearing that, Carter’s heart went out to the kid. He hadn’t realized he was so far from home, but could relate to having parents who always seemed to be someplace else. “It’s gonna be okay, Nick,” he tried to reassure him, as he helped roll the boy’s bed out of the room. “I’ll be right here with you the whole time. Isn’t that right, Dr. Benton?” Across the gurney, he caught his mentor’s eye and raised his brows, begging for silent permission to scrub in for the surgery. Benton stared at him for a second, seeming to consider his request, then gave a brief nod. Carter couldn’t help but grin. His day just kept getting better and better.

In the scrub room, they were joined by Dr. Angela Hicks, the surgical attending who would be overseeing Nick’s operation. “Care to catch me up to speed?” she asked, as she worked the antibacterial scrub solution into a thick lather to begin the lengthy process of washing and decontaminating her hands.

“Patient is a fifteen-year-old male who sustained a seatbelt injury in an MVA this morning,” Benton began in his usual, matter-of-fact manner, as he meticulously scrubbed each finger with a brush. “His condition was initially stable, but decompensated in the ER.”

“His name’s Nick,” Carter added, using a nail pick to clean beneath his fingernails, “and he’s pretty scared. From what I understood, he’s from out of town; his parents are in Florida.”

Benton gave his student a long look before continuing, as if he hadn’t spoken, “Upon examination, the belly was distended, rigid, and tender with decreased bowel sounds, and the abdominal ultrasound showed free fluid in the left upper quadrant.”

“Did you get a CT scan?” Hicks wanted to know.

“No. I wasn’t comfortable waiting for a CT with as unstable as the patient’s pressure was,” Benton answered coolly. Carter paused his scrubbing, waiting to hear if his mentor was about to be reprimanded for this decision, but Dr. Hicks simply nodded.

“Hence the need for an emergency ex-lap,” she concurred. “Mr. Carter, what kind of injuries should we be looking for based on the ultrasound findings?”

Caught off-guard by the question, Carter’s mind began to race, trying to remember which organs were located in the left upper quadrant. “Um… something involving the spleen?”

To his relief, Hicks gave another nod. “A splenic laceration is the most likely cause of blood in the upper left quadrant, but it’s not the only possibility. We’ll also need to carefully examine the left kidney, along with the diaphragm, bowel, bladder, and surrounding anatomy, as blood from an isolated injury to one of those areas tends to collect in the upper left quadrant.”

“Sounds like a plan,” said Carter, trying to sound confident as he continued to scrub. Based on his previous experiences in the OR, he would probably be doing more observing than actual assisting, but if he continued on the surgical path, there would come a day when he had to know all this stuff himself. It was a lot to remember.

When he was fully gowned up and sterile, he followed Hicks and Benton into the operating room, where their patient was prepped, but still awake.

“Hi, Nick,” Carter said when he saw that the boy’s blue eyes were open. He smiled automatically before he remembered he was wearing a surgical mask over his mouth and nose.

Nick blinked, and the cloud of sleepiness in his eyes cleared momentarily when he recognized the face behind the mask. “Hi, Dr. Carter,” he replied faintly. Beneath the bright fluorescent light, his own face looked ghostly white.

In spite of the concern he felt for his patient, Carter couldn’t help but smile at being called “Doctor.” He didn’t bother to correct him. “How are you feeling?” he asked instead.

“C-cold.” Lying unclothed on the hard surgical table, the poor kid was shivering violently beneath the thin sheet that covered him. They always kept the air in the OR cool, but Carter suspected the combination of shock and nerves were contributing to his body’s reaction.

Carter gave a sympathetic nod. “It’s chilly in here, I know.” Looking around, he spotted the scrub nurse, Shirley. “Can we get him a blanket or something?” he asked her.

“We’re about to put him under,” the anesthesiologist, Dr. Babcock, answered brusquely before the nurse could. “He’ll be fine.”

Carter frowned beneath his mask. He wished he could hold the boy’s hand or brush back his hair, anything to bring him some comfort while he was still conscious, but he knew he couldn’t touch him while he was sterile. If he contaminated his gloves, he would have to go back into the scrub room and start the sterilization process all over again. Then he would miss the beginning of the surgery, and Benton would be annoyed with him. So he held back, hoping he could comfort the kid with words instead. “Hang in there, Nick,” he said. “We’re gonna give you some medicine to make you fall asleep. In a few minutes, you won’t feel a thing.”

Nick nodded, his Adam’s apple bobbing in his throat as he swallowed hard. “What if I don’t wake up?” he asked in a whisper, fear flickering in his blue eyes.

“Don’t you worry about that,” Carter tried to reassure him. “We’ll get you through this, Nick. You’re gonna be just fine.” In the back of his mind, he knew he shouldn’t make any promises - no procedure was without risks, and emergency surgeries such as this could be especially perilous - but now wasn’t the time to talk about potential complications. He wanted his young patient to feel as calm as possible in his last moments of consciousness.

“All right, Mr. Carter,” said Dr. Babcock. Carter looked up instinctively, only to realize he was talking to Nick, not him. “You’re gonna feel yourself getting sleepy now.” As he spoke, the anesthesiologist pushed down the plunger on the syringe in his hand, slowly dispensing a dose of sedative into Nick’s IV line. “I want you to slowly count backwards from ten for me. I doubt you’ll make it to one. When you wake up, it’ll all be over.”

Nick nodded, taking a deep breath before he began to count. “Ten… nine…” On seven, his speech started to slur, and by four, his eyelids were drooping. His tongue tried to form the word “three,” but failed, his mouth falling open as he faded into unconsciousness.

“He’s out. Get ready to intubate,” Babcock told the respiratory therapist, as he prepared to administer the paralytic.

Carter took a step back, giving the respiratory therapist room to insert a breathing tube. “What should I do, Dr. Benton?” he asked his mentor, hoping to be assigned an interesting task this time. He was tired of just watching, but knew better than to complain. Benton could be vindictive; he had once punished Carter for being late by forcing him to hold up a patient’s heavy arm for the duration of an operation, even though the OR had a perfectly good pulley system that could have served the same purpose.

“You can suction for me,” said Benton, as he took his place on one side of the table, across from Dr. Hicks.

Carter was delighted. Being responsible for sucking the excess blood and fluids out of the surgical field would put him right in the center of all the action. Besides, it looked like fun.

The nurses finished creating a sterile field by pulling back the sheet to expose the patient’s body, placing blue surgical drapes around his abdomen, and painting his bare skin with antiseptic.

“Ten blade, please, Shirley,” said Benton, and the scrub nurse promptly handed him the scalpel. “I’ll begin by making an upper midline incision.” He ran the blade smoothly down the center of Nick’s torso from the bottom of his sternum to just above his navel. As he deepened the incision, dissecting through layers of subcutaneous fat to reach the lining of the abdominal cavity, he continued to narrate each step of the procedure for both his student’s benefit and his boss’s approval. “Now I’ll enter the peritoneum...”

“Be careful that you don’t cut too deep and injure the intraperitoneal contents,” Dr. Hicks warned, keeping a watchful eye on her resident as he made a small and shallow incision in the thin membrane surrounding the abdominal organs. Immediately, blood began to bubble up through the opening, as a foul smell filled the operating room.

“Damn,” Benton swore. “Suction!”

Carter’s stomach churned as he swept the suction wand over the incision to suck up the blood. It seemed to be coming out as quickly as he could clear it away. “Did you nick an artery?” he asked, his heartbeat accelerating.

“No, Carter, I didn’t nick anything,” Benton replied defensively, as he cut a wider opening to get a better look at the organs within. “His belly’s full of blood.”

“Probably a perfed bowel. Janet, hang another four units of type specific on the rapid infuser,” Hicks said to the circulating nurse. “We don’t want him bleeding out.”

“Turn up the suction,” Benton snapped at Carter, as the nurse hurried to transfuse more blood. “I can’t see a damn thing in here. Lap pads, please.”

Carter did his best to keep up with the suctioning while Hicks helped Benton pack the patient’s abdominal cavity with absorbent gauze pads so they could locate the source of the bleeding. All of a sudden, a torrent of bright red blood spurted out of the opening, spattering the front of Carter’s surgical gown.

“We got a pumper!” cried Benton, as Carter instinctively jumped back out of the way. “Carter - suction!”

Swallowing hard, the med student forced himself to take a step forward. He fought against his nausea as he stuck the suction wand back into the boy’s belly, trying to clear away as much of the blood as he could so the surgeons could see where it was coming from.

In the background, he could hear one of the monitors issue a high-pitched alarm. “His pressure’s crashing,” the anesthesiologist warned them.

Benton shook his head, looking down in dismay. “He’s losing blood faster than we can give it to him.” Carter’s heart sank as he watched Nick’s abdominal cavity refill with blood, despite his best efforts to keep up with the suctioning.

“He must have blown a clot,” said Hicks. “Could be a mesenteric rupture. Cross-clamp the aorta.”

Carter knew this was a risky move; it meant cutting off circulation to the lower half of the kid’s body, which could result in dead tissue and permanent damage. But it was a necessary risk: if they didn’t take drastic measures to stop the flow of blood, Nick would hemorrhage to death before the two surgeons could repair the tear in his artery. Either way, they were in a race against time now.

“He’s bradying down,” said Babcock, as Nick’s heart rate dropped.

“I need more suction!” barked Benton as he bent over the operating table, his blood-soaked hands buried in the boy’s abdomen.

“I’m trying, but it’s turned up as high as it will go!” Carter insisted, making another sweep with the suction wand.

“We’ve lost his pulse!” Babcock cried, as the beeping of the cardiac monitor slowed. “He’s in PEA.” Another alarm sounded, and suddenly, the separate blips were replaced by one long, continuous whine. Carter glanced up to see the waveform flatline as Nick’s heart stopped. “No, asystole.”

“Aorta’s clamped. Carter, start CPR,” Benton ordered, catching his student off-guard.

“But I’m sterile,” Carter started to protest, holding up his gloved hands.

“That doesn’t matter anymore. If we don’t keep his heart pumping, the kid’s dead anyway. He needs external cardiac massage - now!”

Carter hesitated only a second before he handed the suction wand to Dr. Hicks and scrambled up onto the footstool the circulating nurse had placed next to the operating table. He bent over Nick’s body, positioned his hands between the boy’s nipples, and began chest compressions.

“Run in two more liters of type-specific,” Dr. Hicks said over the loud rattle of the suction system. “We need to get his blood volume back up before we can restore a heartbeat.” Carter marveled over how she managed to remain so calm and collected while a kid was dying on the operating table right in front of her. He supposed that was what made her such a successful and well-respected surgeon. His own mind was racing, but he tried to concentrate on the rhythm of his compressions and block out the rest.

“Hang on, Nick,” he chanted, as he pumped the patient’s chest. Sweat poured from his brow, and his breath came in short bursts behind his mask. He could already feel his arms getting tired, but he pushed through the fatigue. Against his better judgment, he had all but promised this poor boy he was going to be fine, and he was determined to fulfill that promise.

“Looks like you were right, Dr. Hicks,” he heard Benton say in the background. “There’s a small laceration in his superior mesenteric artery.” This was the vessel that supplied blood to the lower gastrointestinal tract, Carter recalled from his anatomy classes.

“Tie it off so we can unclamp the aorta before we begin the repair,” Hicks advised. “Remember, time is tissue.”

“The rapid infuser’s finished, Dr. Hicks,” said the nurse who was handling the transfusion. “Do you want any drugs or more blood?”

Dr. Hicks looked up at the clock. “How long has he been down?”

“Almost two minutes.”

“Let’s try an amp of epi,” said the attending. “Will someone please take over CPR for Mr. Carter?”

“No, I’m okay,” Carter replied breathlessly, as he kept pumping. “I can go another round.” The muscles in his arms and back were screaming for a break from the constant pushing motion in a bent over position, but he wasn’t ready to stop.

“Suit yourself,” she replied. “Let us know when you get too tired to maintain high-quality compressions, and one of us will trade places with you.”

Carter nodded, hoping their patient’s heart would be beating again before he got too tired to continue. He was just a kid… a kid who had been awake and talking only half an hour ago. Carter could still see the look in his eyes when he had asked, “What if I don’t wake up?”

“Don’t you worry about that,” he heard his own casual, almost cavalier response. “We’ll get you through this, Nick. You’re gonna be just fine.”

“C’mon, Nick,” he murmured, his breath catching in his throat. “Stay with us.” He went on massaging the boy’s heart, while Hicks and Benton worked frantically to restore blood flow to his bowels.

After what felt like forever, he heard the circulating nurse say, “It’s been two minutes since the last epi. Let’s pause for a pulse check.”

Carter straightened up, his arms burning, his lower back aching, and looked automatically at the cardiac monitor. To his relief, he saw the line rise and fall… then rise again - a near perfect waveform.

“We have a beat,” Babcock announced triumphantly. “Looks like a normal sinus rhythm.”

“I feel a faint radial pulse,” the nurse confirmed as she palpated Nick’s wrist. “BP is ninety over sixty-five and rising.”

“Nice save, everyone,” said Dr. Hicks. Her brown eyes crinkled at the corners as she looked around the operating room, acknowledging each member of the surgical team. “We got him back. Now we just need to maintain his pressure and preserve as much of his bowel as we can - right, Dr. Benton?”

“Mm-hm,” replied Benton without bothering to look up, his hands still busy inside Nick’s belly.

Carter stepped down from the footstool on shaky legs and let out his breath in a long sigh. He felt like he had just finished a marathon, yet the surgery was far from over. “You think he’s gonna pull through?” he asked, looking over his mentor’s shoulder.

“I can’t make any promises,” muttered Benton. He didn’t sound overly optimistic, but then, he wasn’t exactly known for his upbeat personality. Perhaps he realized this because, after a moment, he added, “But I think he probably will, thanks to you.”

Carter blinked in surprise. “Me?”

Benton glanced up. “You kept his blood pumping, didn’t you? And you didn’t panic or pass out this time - that’s progress. Good work, Carter.”

Taken aback by this rare compliment, Carter hardly knew how to respond. “Thanks,” he finally managed to say. Behind his mask, he couldn’t help but smile.

***

Chapter 8

When he first woke up, Howie Dorough didn’t know where he was. He definitely wasn’t home, for the bed beneath him was too hard to be his own. Hotel room, he thought vaguely, remembering that they were on the road.

As he gradually regained consciousness, he began to recall more details. He was in Chicago. With the Boys. For the radio tour. It was cold outside. Even with his eyes closed, he could picture Nicky bouncing on the balls of feet to stay warm, his hands shoved deep into the pockets of his parka. Raindrops rolling down his window. Heavy fog obscuring his view of the tall buildings, making it hard to see more than a few feet in front of the van they had ridden in on the way to the radio station. Suddenly, he remembered the sound of brakes screeching. Screaming. The sickening crunch of metal as the van crashed into the guardrail. He remembered the feeling of flying forward, his face striking the rain-soaked window. He remembered the pain in his head and the fear in his heart.

He could still feel both, but the cold was gone. The fog seemed to be swirling around inside his brain instead of outside his window. The sound of raindrops drumming on the roof of the van had been replaced by a soft and steady blip… blip… blip… that he recognized as a recording of his own heartbeat. Hospital room, he realized.

When he finally became aware of his surroundings, Howie tried to force his eyes open. It was hard work: his eyelids felt like lead weights, too heavy to lift. He only succeeded in opening the left one; the right side seemed to be swollen shut. Instinctively, he tried to reach up to feel his face, only to find that his hands had been tied to the rails of his hospital bed. He tried to call out for help, only to realize there was a tube in his throat that prevented him from speaking. He rattled the bedrails instead, until a nurse appeared at his side.

“Shh, you’re all right, Howie,” she said soothingly, running her hand over his shoulder. “Relax. You just woke up from surgery. You need to rest.”

Surgery? he wondered, his mind racing. The last thing he remembered was going for a CAT scan. His head had been hurting even worse than it was now, and he had been worried about the others. AJ. Nick. Kevin. Brian. Lou. Denise. Were they okay? He couldn’t recall having seen any of them since the accident.

“My name’s Kit,” the nurse told him. She had a kind, friendly face, framed by a tangle of frizzy, black curls. “I’m taking care of you while you’re here in the recovery room. Don’t try to talk; you still have a tube down your throat to help you breathe. Blink twice if you understand.”

Howie tried to concentrate on what she was saying, but it was a struggle. His thoughts felt scattered and strangely muddled. Still, he managed to open and close his good eye two times to show he could comprehend her words.

“Very good. Can you squeeze my hand?” she asked, coiling her fingers around his. He didn’t like the rubbery feel of her latex gloves against his skin, but he reluctantly followed her instructions and squeezed. Kit smiled. “Great job, Howie. I’m going to go call your doctor to come take a look at you. I’ll be right back.”

She left him in confusion, pulling the curtain around his bed so he couldn’t see what was beyond it. He wondered where the other guys were and whether anyone had called his family in Florida. He had never felt so scared and alone.

The curtain rattled open again a few minutes later, as a man in a white coat and blue scrubs came around it. Howie didn’t recognize him. He had been expecting to see the same doctor who had examined him in the emergency room - tall, thin, and balding, with wire-framed glasses - but this one was shorter, older, and wore no glasses.

“Hi, Mr. Dorough,” the new doctor greeted him, removing the restraints from around Howie’s wrists so he could grip his right hand. “I’m Dr. Halloran.” He took a pen light out of the front pocket of his coat and shone the bright beam into Howie’s eye. “Follow my light, please,” he said, moving it slowly back and forth. “Good. Now let me take a quick listen here.”

Reaching for the stethoscope from around his neck, he slipped the earpieces into his ears and slid the chestpiece down the front of Howie’s hospital gown, frowning in concentration. Howie felt his chest rise and fall automatically as air was forced into his lungs through the tube in his throat. It was a strange sensation, but rather than becoming accustomed to it, he was growing more and more uncomfortable. The tube felt intrusive, like it was choking him rather than helping him to breathe.

“I bet you’re ready to get rid of that tube, huh?” said Dr. Halloran, as if he could read Howie’s mind. When Howie nodded, he unhooked the thick hose that was attached to the end of the narrow tube. The feeling of choking increased as the air stopped flowing, and for a second, Howie was overwhelmed with a sense of sudden dread. “Try to take a deep breath for me,” the doctor said calmly.

I can do that, thought Howie, fighting back his panic as he concentrated on filling his lungs. It took more effort than he had expected, for it felt as if he were sucking air through a straw, but finally, he felt his chest expand as his lungs reinflated.

“Excellent,” said Dr. Halloran, smiling as he removed his stethoscope. “Looks like you’re ready to be extubated.”

When he took out the breathing tube, it felt like he was pulling Howie’s lungs along with it. For the first few seconds afterwards, Howie coughed uncontrollably, tears streaming from his eyes, until he was finally able to catch his breath. Holding his hand to his heaving chest, he tried to relax back against the bed, already exhausted by the coughing fit. His throat felt raw and sore. He swallowed hard before he tried to speak. “What happened to me?” he asked in a whisper, wincing at the hoarseness of his voice.

Dr. Halloran sat down next to his bed and took his hand once more. “You were involved in a serious car accident this morning.”

This morning… Having no sense of how long he had slept, Howie was relieved to hear he had only been out for a matter of hours rather than days. “I know that,” he rasped, “but the last thing I remember was being in the emergency room. How did I get here?”

The doctor gave him a grim smile. “You took a turn for the worse while you were getting scans done. Besides a fractured eye socket, the results showed an epidural hematoma - a collection of blood between your brain and skull caused by the head injury you sustained in the accident. We had to rush you into emergency surgery. Fortunately, we were able to control the bleeding before it put too much pressure on your brain and caused permanent damage. You’re going to be just fine, Mr. Dorough.”

Howie gaped at him in disbelief. “I had brain surgery??” It wasn’t until he reached up and felt the gauze dressing taped to the tender right side of his head that he realized Dr. Halloran was telling him the truth.

The neurosurgeon nodded. “You’ll need to take it easy for a few weeks while you heal, but you should make a full recovery.”

Howie wasn’t sure whether to feel relieved or horrified.

“What’s your pain level, Howie?” his nurse, Kit, wanted to know. “How would you rate it on a scale of one to ten, ten being the worst pain you could imagine?”

He paused to consider this. “I dunno… four?” His neck was stiff, and he could feel a dull ache radiating from somewhere behind his swollen right eye, but whatever painkillers they had given him were keeping it under control for now.

She nodded. “Okay. Let me know if it gets worse. We can always give you more morphine.”

“Thanks,” said Howie, but he wasn’t concerned about pain management at the moment. Now that he knew what had happened to him, his thoughts had turned back to his bandmates. “Do you know how my friends are doing?”

Kit glanced at Dr. Halloran. “Why don’t we let someone else finish filling him in?” she suggested with a wry smile, pulling back the curtain surrounding his bed.

Howie felt confused at first, until the nurse stepped aside so he could see who was lying in the next bed.

“Hey, sleepyhead,” said Kevin in his slow drawl, flashing him a loopy smile. “I been wondering when you were gonna wake up.” He looked tired and heavily medicated, but it was a relief to see at least one of the guys awake and talking.

“We’ll give you two a chance to catch up,” said Dr. Halloran, standing up. “I’ll be back to check on you later, but in the meantime, let Kit here know if you need anything.”

Howie nodded gratefully. “Thanks, Doc.” Once the surgeon left, he turned his attention back to Kevin. “You okay, Kev?”

Kevin gave a brief nod, grimacing as he looked at his right leg, which was elevated and wrapped in a thick layer of bandages. “I will be… in a few months or so. I’ve got a metal rod running through the middle of my leg now. Broke both bones below my knee.”

“Ouch.” Howie cringed. “That’s one way to get out of dance rehearsals for a while.”

Kevin chuckled. “If only I hated them as much as Brian does. I bet he…” But he trailed off before he could finish, his smile fading along with his voice.

Cold chills shot down Howie’s spine. He frowned, suddenly overcome with fear. “Kevin, what about the other guys?” he asked. “Are they… all right?” He was almost afraid to hear the answer. Based on the look on Kevin’s face, he could already tell it wasn’t going to be good.

Tears had welled up in Kevin’s green eyes, and his voice trembled when he said, “Brian’s in bad shape. We almost lost him, Howie.”

Howie listened in horror as Kevin recounted what he had witnessed in the emergency room. “Oh my god… Kev…”

“They brought him back,” Kevin continued shakily, wiping his eyes, “but nobody knows if he’s ever going to be… you know… ‘normal’ again. He could have brain damage. He might never wake up.”

Howie shook his head slowly, ignoring the throbbing sensation inside his skull. “But he could be fine, right?” he countered, refusing to consider the frightening possibility that Brian could remain comatose for the rest of his life. “He could wake up from this and make a full recovery. We have to have faith and hope for the best. That’s what Brian would want us to do.”

Kevin nodded, offering him a watery smile.

“How about Nicky and AJ?” Howie asked next.

“Last I heard, they were both still in surgery,” Kevin replied. He raked a hand through his dark hair, looking like he would rather start ripping it out. “They let Denise in to visit me for a few minutes after I woke up, since my mom hasn’t made it here yet. She’s on her way, but it’s like a six hour drive. Your folks are flying in from Florida. Denise called all our families.”

“That’s good,” said Howie, relieved to hear that his parents were coming. At twenty-two, he may have been an adult, but he still wanted his mom and dad with him while he was in the hospital. “So Denise is okay?”

“Yeah, she’s a little banged up, but nothing too bad.”

“How bad were the boys hurt?”

Kevin shook his head. “I dunno… I saw Nick in the ER when he came in with Brian. He seemed okay, but Denise said he collapsed after they took me away to get X-rays. They thought he had some internal bleeding.”

“Damn… that sounds serious,” said Howie, swallowing hard. Poor Nicky… he was so young compared to the rest of them, still just a kid. He had to have been scared, undergoing emergency surgery without his parents or “big brothers” around. They were all protective of him, and Howie wished he or Kevin could have been there to hold his hand and offer him some words of comfort before he went under the knife.

Kevin sighed. “I know... and meanwhile, AJ might be paralyzed.”

“What?!” Howie gasped, his heart plummeting into his stomach.

Fresh tears had filled Kevin’s eyes. “Denise said he has no feeling below the waist,” he said grimly. “The scans showed some broken vertebrae compressing his spinal cord. They took him into surgery to try to repair it, but the doctor said they may not be able to reverse the nerve damage.”

“Oh my god.” Howie shook his head. He couldn’t imagine someone like AJ being confined to a wheelchair for the rest of his life. AJ had been the original Backstreet Boy and was arguably the most talented one of them all. This could ruin his dreams of being a star and end his career before it had even really begun.

He was still reeling over the possibility that AJ would be rendered a paraplegic when he heard Kevin say, “There’s something else...”

Howie’s heart skipped a beat. Kevin’s tone told him he was about to receive more bad news... perhaps the worst news of all. “What?” he whispered, looking up in trepidation.

“Lou’s dead.”

All the air rushed out of Howie’s lungs, leaving him feeling completely deflated. “No...” He shook his head, not wanting to believe it. Not Big Poppa, the man who had brought them together, helped them get their record deal, and made their dreams come true. It couldn’t be.

Kevin didn’t have to say anything else. The tears trickling freely down his cheeks confirmed he was telling the truth. He and Lou had always seemed especially close; since Kevin’s dad had died four years earlier, Howie knew he had looked to Lou almost like a second father. For Kevin, losing Lou must feel like he was losing his real father all over again. Howie hated that he had to relive something like that.

“I’m so sorry, bro,” he murmured, knowing there was nothing he could say to take away the pain. He wished he could reach across and squeeze Kevin’s hand, but the gap between their beds was too wide, and he was too woozy to try getting up. The throbbing inside his head had intensified, but Howie couldn’t tell whether it was true, physical pain or just a manifestation of his emotional turmoil.

“Mr. Richardson?” A couple of orderlies had come up alongside Kevin’s bed. “We’re ready to move you to your regular room now,” one of them announced, unlocking the wheels so the bed would roll smoothly across the tiled floor.

Kevin looked back anxiously at Howie. “Can you keep the two of us together?” he asked.

The orderly checked the chart hanging on the end of Howie’s bed before he shook his head. “Sorry, but no. You’re heading to one of the general floors, but Mr. Dorough here has to go to the ICU first.”

Howie swallowed hard. The intensive care unit? The mere mention of it made his blood run cold, as if icy fingers had wrapped around his heart and squeezed. It sounded frightening - not the sort of place he wanted to be. He wished he could go with Kevin instead, but knew there was no point in begging. He didn’t want to sound like a baby.

“Hang in there, bro,” said Kevin, wiping his eyes as they wheeled him away.

When Kit came back to check on him, Howie asked her for more morphine, hoping it would help numb the pain in his heart as well as his head. He drifted into a drug-induced haze, dozing until another team of nurses and orderlies came to transport him to his new room, too.

He was relieved to see that the ICU was not nearly as scary as he had imagined it to be. It looked like a typical hospital room, just with more monitors and equipment around each bed. He was slightly disappointed, though not surprised, to discover that he had a roommate. The bed next to his was already occupied, a privacy curtain pulled closed around it.

Not long after the nurses had helped him settle in, he heard a knock at his door. He looked up to see a lanky, balding man leaning in the doorway. Beside him was a young woman with dark blonde hair cut into a short bob. “Hi, Howie. Are you up for a visitor?”

“Uh… sure,” Howie replied uncertainly. He didn’t recognize either one of them until he noticed the man’s round, wire-rimmed glasses and suddenly realized who he was. “How are you, Dr. Greene?”

The emergency room physician smiled as he walked into the room. “I was just about to ask you the same question. Your memory seems to be intact. That’s a good sign.” He had traded his white coat for a gray jacket, which he wore over his green scrubs. “This is my friend Dr. Lewis,” he introduced the woman with him. “We were on our way out when I realized I never got a chance to talk to you about your friends like I said I would. Sorry about that - things got pretty hectic there for a while.”

“That’s okay,” said Howie, the side of his face hurting as he forced a smile back. “I saw Kevin in the recovery room earlier; he filled me in. He said Nick and AJ were still in surgery. Do you know anything else about them?”

Dr. Greene gave a nod. “I just checked with the OR and was told they’re both out of surgery and resting comfortably in the pediatric intensive care unit.”

Howie felt a rush of relief. “That’s good to hear,” he replied, grateful for the update. “Thanks.”

“I treated Kevin in the ER,” the female doctor inserted before he could ask any more questions. “He was concerned about you all, too. You guys must be pretty close, huh?”

Howie nodded. “We’re like brothers.” As he looked up at Dr. Lewis, another thought occurred to him. “Hey, are you the one who took care of Brian, too?” He remembered Kevin describing the doctor who had refused to give up on his cousin, even when the rest of the staff seemed to have written him off as a lost cause.

Dr. Lewis flashed him a tight smile. “That’s me.”

“Kevin told me what you did… how you wouldn’t give up until you got his heart beating again.” Howie’s eyes filled with tears as it hit him again how close they had come to losing Brian. “Thank you… thank you for saving his life.”

“It was a team effort,” Dr. Lewis replied humbly, glancing at Dr. Greene, “but you’re welcome. I hope he’ll be all right. He still has a long road ahead of him.”

The hesitant tone of her voice told Howie she wasn’t too optimistic about Brian’s odds of recovery. He swallowed hard, his throat dry. “Have you heard anything about how he’s doing?”

“I just came up here to check on him before I headed home, actually,” said Dr. Lewis. And to Howie’s astonishment, she pulled back the curtain between the two beds to reveal…

“Brian?!” he cried in disbelief, hoisting himself up onto his elbow for a better look at his roommate.

It was Brian, all right, but he was barely recognizable. His blue eyes were closed, the rest of his face half-hidden behind a pair of hoses that were hooked to the breathing tube protruding from his mouth. There was a nasty bruise on his forehead, and his neck was wrapped in a bulky brace that went from his chin to his chest. His small body appeared lost within a maze of tubes and wires that wound their way to the assemblage of machines surrounding his bed.

“I told them to put you two together if possible,” said Dr. Greene, looking pleased with himself.

Meanwhile, Dr. Lewis was bent over Brian, listening to his bare chest with a stethoscope. “His lungs sound mostly clear,” she said after a moment, “and his color looks a little better.” She seemed encouraged by this observation.

Howie cleared his throat. “B-Rok!” he called across the room. “It’s me, Howie D. I’m right here with you, man.”

He waited, watching hopefully for some sign that Brian had heard him and recognized his voice, but there was no response. Brian remained unconscious, his body still except for the steady rise and fall of his chest as a ventilator pumped oxygen into his lungs. Howie remembered how uncomfortable he had felt being on the breathing machine, but Brian didn’t seem bothered by it. His pale face looked blank, but peaceful. At least he didn’t appear to be in any pain.

“He’s been put into a drug-induced coma,” Dr. Lewis explained. “It’s a new technique that’s supposed to help protect his brain from further damage and give it time to heal.”

Howie frowned. “How long will the coma last?”

“They’ll start reducing his dose of sedatives sometime in the next few days and see how he responds, but there’s no guarantee he’ll regain consciousness,” she replied grimly. “At this point, we just have to wait and see.”

He followed her gaze back to his friend. It was weird seeing someone as active and energetic as Brian suddenly rendered so lifeless. Howie remembered what Kevin had told him: “Nobody knows if he’s ever going to be… you know… ‘normal’ again. He might never wake up.”

As much as Howie didn’t want to imagine a world without Brian in it, he couldn’t help but worry about what the future would hold for his bandmates and him. They had worked so hard to make their dreams come true, and just when it seemed that all the blood, sweat, and tears they had put in were about to pay off, everything had fallen apart. After spending so much time together over the past few years, the five of them had become a family. There had been a Backstreet Boys before Brian, but Howie didn’t see how they could go on as a group without him. He was the missing piece they had been looking for to complete their quintet, and if they lost him, they would never be whole again. The same could be said for Nick and AJ, who had been with Howie since the beginning, and for Kevin. Their five voices and personalities complimented each other perfectly.

Yet, even if Brian managed to pull through and make a miraculous recovery, they would still be missing an integral part of what had made them the Backstreet Boys. Lou, their founder and fearless leader, was gone. They had always joked that Lou was like the sixth Backstreet Boy. Without him at the helm, Howie had no idea where the group would go from here.

His head pounded as tears prickled in the corners of his eyes, blurring his vision. Brains and bones could heal... but suddenly, the Backstreet Boys seemed broken beyond repair.

***

Chapter 9

AJ McLean had never been more miserable in his life. He had spent the last three days lying immobile in bed, listening to the beep of his monitors and the moans of his roommate.

“No… it’ll hurt…” he heard the familiar whine begin just before breakfast, as the doctors were finishing up their morning rounds.

“Aww, come on now, Nick,” said the medical student who was standing by the next bed, trying to convince its cranky occupant to let him change his bandage. “Have some faith in me here.” He flashed a good-natured grin as he pulled on a pair of gloves. “I’ll be gentle. I promise.”

Nick sighed. “Fine,” he huffed, throwing his head back against his pillow. Watching from the other side of the room, AJ rolled his eyes. Nick could be so dramatic sometimes.

As the two youngest members of the Backstreet Boys, AJ and Nick normally got along well. They had shared hotel beds and tour buses with no problem, but sharing a hospital room had tested AJ’s patience.

At first, he had been relieved to see Nick being rolled into his room after surgery. It was nice having someone he knew in the next bed - someone he trusted, someone he could talk to, someone who could keep him company as they both recuperated from their respective operations.

But as it turned out, Nick didn’t want to talk. “Just lemme sleep,” he would mumble when AJ tried to strike up a conversation, closing his eyes and pulling the covers up over his face to block out the light. AJ would be left to lie there and stare at the ceiling, unable to sleep.

While Nick spent most of the day napping, AJ hadn’t gotten more than a few hours of restless sleep since the accident. The rigid back brace they had put on him to protect his spine as it recovered was restrictive and uncomfortable. He couldn’t even roll over by himself, relying on a team of nurses to reposition his broken body every few hours to prevent pressure sores from forming. He found himself looking forward to their arrival, yet whenever they came to turn him, he felt a fresh wave of horror, wondering if he would spend the rest of his life like this, unable to move the lower half of his body. He hated feeling so helpless.

It was hardest at night, when visiting hours were over and the lights were out and the TV had been turned off, taking away everything he used to distract himself from his discomfort during the day. That was when the fear and depression really set in. He would lie awake for what felt like forever, listening to the unfamiliar sounds of the ICU. He tried to block out the blips and drips and focus instead on the steady, reassuring sound of Nick’s deep breathing, hoping it would help lull him to sleep. He squeezed his eyes shut, wishing he would wake up to find himself back in his hotel room bed and realize it had all been a bad dream. But when he did finally drift off, he would have flashbacks of the accident and wake with his heart racing, only to discover that the nightmare was real. As a result, he was irritable and more prone to snapping at people... especially his equally bad-tempered roommate.

“Suck it up, Carter!” he called across the room. “It’ll just be like ripping off a really big Band-Aid.”

Nick whipped his head toward AJ, his blue eyes widening with horror. “Dude, that’s what I’m worried about!”

The med student, whose last name was also Carter, had turned to look at AJ, too. “You sure you don’t want that curtain closed?” he asked Nick uncertainly.

“Nah, it’s fine,” said Nick with a sigh. The privacy curtain between their beds was almost never closed; they both preferred it open. When the nurse had started to pull it across the middle of their room on the first night, Nick had protested, claiming he didn’t want to be alone. Privately, AJ agreed; the curtain made him feel claustrophobic, as if the walls of the windowless hospital room were closing in on him. If he couldn’t see outside, he at least liked to be able to look across and see Nick on the other side of the room. “Me and him go way back,” Nick added, waving his hand toward AJ. “We’re like brothers. We don’t have any secrets.”

That made AJ smile. In actuality, he and Nick had only known each other for three years, but they had spent so much of that time together that it felt like a lot longer. Nick was right: they were practically family by now.

“Okay,” said the older Carter with a shrug, returning his attention to the younger one. He loosened the ties holding the back of Nick’s hospital gown together and eased the front over his shoulders, pulling it down just far enough to expose the large gauze dressing taped down the length of his torso. “Close your eyes and take a deep breath,” the doctor-in-training told his patient, and when Nick complied, he carefully peeled back the edges of the bandage. “See? I knew you were tough,” he said, as he set the bloodstained gauze pad aside. “All us Carters are.” In his crisp white coat and neatly pressed khakis, this Carter didn’t look particularly tough, but at least he seemed nice.

Nick opened his eyes and cracked a smile. “You saying we’re related?”

The other Carter shrugged. “Well, Carter’s a pretty common name, but there could be some connection, right?” he replied, as he inspected Nick’s surgical incision.

“I doubt it,” said Nick flatly. “My dad was adopted, so I’m not really a Carter. Besides… I can’t see anyone in my family becoming a doctor.” He grimaced as he followed the med student’s line of sight to his bare belly. “Ugh… that is so gross.”

AJ knew better than to say it out loud, but privately, he agreed. With the curtain left open, he couldn’t help but watch with morbid curiosity as Carter carefully probed Nick’s abdomen. It wasn’t a pretty sight; the poor kid looked like he had been gutted. The incision running down the center of his stomach was red and raised, the skin still slightly swollen between the staples that had been used to put it back together. But Carter seemed pleased by its appearance.

“Actually, the wound looks like it’s healing well,” he said, gently touching the edges with his gloved finger. “We’ll be able to remove the staples in another week or so.”

“Will that hurt?” Nick wondered nervously.

“Nah, not too bad. It’ll feel better once they’re out,” Carter replied. “It’ll look a lot better, too. Once this is fully healed, you’ll have a pretty gnarly scar to show off.”

Nick made a face. “I’ll never be able to go shirtless again…”

AJ snorted. “You hardly went shirtless before!” He knew Nick had always been self-conscious around the other guys, who were all older, with more muscle definition and actual chest hair they had to shave. They looked like men without their shirts, while Nick still looked like a little boy.

“Hey, listen - chicks dig scars,” Carter said sagely.

“Yeah, right,” said Nick, rolling his eyes.

“No, really. It’s true!” insisted Carter, unwrapping a clean bandage to cover the incision. “I once dated a girl who dumped me for a guy with a cool scar.”

AJ shook his head skeptically. “You did not.”

Carter offered a sheepish shrug. “Well, that may not have been the actual reason she broke up with me, but…”

Both boys snickered, Nick wincing in pain. “Owww,” he whined. “Don’t make me laugh.”

The med student offered him a sympathetic smile. “Still pretty tender, huh?” Nick nodded. “You may be sore for a few more weeks, but you’ll be back to playing basketball before you know it,” Carter promised, as he put on the new bandage.

Looking away, Nick said nothing. AJ knew what he was probably thinking: basketball would be no fun without Brian around to shoot hoops with him. None of the other guys loved the sport the way Frick and Frack did.

Carter also noticed Nick’s sudden silence, though he didn’t seem to know its cause. “Are you really still in a lot of pain?” he asked again, as he carefully smoothed down the edges of the dressing. He kept his voice casual, yet he sounded slightly concerned. Nick just nodded. “From the incision itself or inside your belly?”

Nick shrugged. “I dunno... it just aches all over,” was his vague answer.

Though he cared about Nick, it was hard for AJ to feel too sympathetic toward him when he was whining as if his pain was the worst in the world. Recovering from major abdominal surgery couldn’t be much fun, but AJ thought the kid should show a bit of appreciation for the fact that he was still alive and able-bodied. Not all of them were: Lou was dead, Brian was comatose, Kevin was laid up with a broken leg, and AJ was paralyzed. At least Nick could feel something. Meanwhile, AJ was still numb below the waist, though the agonizing pangs he felt in his lower back more than made up for the lack of sensation in his legs. He hadn’t been able to see the incision from his own operation, but he imagined it looked like a length of angry, red railroad track running up his spine, radiating shockwaves of pain that could only be controlled by regular doses of morphine pumped directly into his veins.

Carter felt Nick’s abdomen in a few different places, gently poking his gloved fingers into the pale flesh. “The distension in your belly appears to have gone down since yesterday, which is a good sign,” he said. “Have you passed gas yet this morning?”

Nick’s face turned bright red. “Yes,” he muttered stiffly. He had been asked the same routine question every day since his surgery to ensure his repaired bowel was working normally again, but he still blushed each time he had to answer it.

AJ couldn’t resist the opportunity to embarrass his friend further. “I can vouch for that,” he chimed in with a grin. “He stunk up this whole place earlier. It smelled like shit.”

“Shut up,” Nick groaned, as the med student chuckled.

“You shut up,” AJ fired back. “Be glad you can still feel a fart coming on. I can’t tell if I’m about to crap my bed or not.”

Nick faked a laugh and looked away, clearly uncomfortable with the conversation. AJ didn’t care. Being completely dependent on nurses to take care of his bathroom needs had forced him to get past his own embarrassment over bodily functions rather quickly. Nick hadn’t been cleared to start eating anything by mouth yet, but the first time he complained about having to get up to take a dump, AJ thought he just might lose it.

“Everything seems to be all right, but I’ll check with Dr. Benton and see if we can increase your dose of pain medication,” Carter promised, pulling Nick’s gown back up to his neck. “I’ll be back to check on you later.”

Not long after he left, an orderly arrived with AJ’s breakfast tray. Nick looked at it longingly while AJ clumsily fed himself cream of wheat, the head of his bed raised to a forty-five degree angle so he could be semi-upright. It wasn’t the most comfortable position from which to eat, and he would have much rather had a Quarter Pounder with cheese and fries from McDonald’s than this bland porridge, but he reminded himself that it could have been worse. At least he still had the use of his hands and was able to eat a real meal, unlike poor Nick, who was restricted to receiving a nutrient paste through a tube in his nose until his intestines had healed enough to handle solid food.

As AJ was finishing his breakfast, Nick’s nurse came in and told him it was time for him to get out of bed.

“No… it’ll hurt…” he started in with the whining again, sounding younger than his fifteen years.

“Now, Nick,” the nurse said in a warning tone. “You heard what Dr. Benton told you yesterday: We need to get you up and moving. Your muscles will start wasting away if you lie here too long without using them.”

AJ had listened to the two of them go back and forth about this for the past two days. First Nick had flatly refused to get out of bed and move to a recliner, complaining that his belly hurt too badly and he just wanted to sleep. After much wheedling and more morphine, the nurse had won that battle. Now, as she tried to get him to take a walk down the hall, Nick dug his heels in even further.

“But my stomach freaking hurts,” he protested, pulling his covers up higher. “I just had surgery, ya know.”

The nurse sighed. “I know. But your surgeon has examined you and doesn’t feel you need to be on strict bed rest. As long as you take it easy, there’s no reason why you can’t get up and walk around,” she said impatiently, while Nick continued to pout. “It’ll be good for you to get some exercise. Not only does it reduce your risk of developing blood clots, but it may even improve your bad mood.”

AJ snorted from the other side of the room. “He could sure use that.”

“Bite me,” he heard Nick mutter under his breath.

“Yeah? Stop bitching about getting out of bed, lazy ass!” AJ snapped back loudly, shoving his breakfast tray aside. In the back of his mind, he could hear Lou start to scold him (“Language!”), before he remembered that Lou was dead. The realization hit him like a sucker punch to the gut. “So your stomach hurts… well, boo-hoo! At least you’re alive! At least your legs still work! I’d give anything to be able to go for a walk right now.”

Angry tears had risen in his eyes, which put an abrupt end to Nick’s complaining. “Sorry, AJ,” he apologized sheepishly, his cheeks turning pink again. “Ya know, if I could trade places with you, I would.”

AJ sighed, wiping away the tears. “No, you wouldn’t.” He knew he sounded bitter, but he couldn’t help giving Nick a hard time. He was bitter, and Nick was acting like a spoiled brat. “And even if you would, you can’t,” he continued, “so quit being a damn baby and do what the doctors and nurses say. They just want what’s best for you.”

“I know,” Nick admitted, picking an invisible piece of fuzz off his blanket. He allowed the nurse to help him sit up on the side of his bed and then stand, as AJ watched with envy. He knew by the way Nick winced with each movement that he must legitimately be sore, but the pain was only a temporary problem. Despite his discomfort, the doctors all said Nick was doing well. In a few more days, he would be discharged, free to walk out of the hospital on his own two feet.

That wasn’t the case with AJ. He was facing weeks of rehabilitation, and the surgeon who had operated on his broken back had made it clear that he might never walk again.

“Your spinal cord wasn’t completely severed, but it was compressed by a couple of fractured vertebrae,” the doctor had explained, showing him a set of X-rays taken before and after his surgery. “You could recover some function below the waist, but you need to face the possibility that you may not. Right now, it’s too early to tell - we need to wait for the swelling in your spine to go down, which can take up to seventy-two hours. We’ll reassess your injury in a few days, and then we can discuss your prognosis.”

AJ hated the uncertainty of waiting and wondering if his paralysis was permanent or not. To pass the time, he had been trying to wiggle his toes whenever no one was watching. He never told his mother or Nick what he was doing, not wanting them to be disappointed when he failed. So far, he hadn’t managed to move a muscle below the waist, yet he sometimes felt a strange tingling in his otherwise lifeless legs. He had tried his best to describe the prickly sensation to his doctor, hoping it was a positive sign, only to be told it was just the result of the nerve pathways in his lower body being interrupted, similar to the sort of phantom pain experienced by amputees after the loss of a limb. AJ yearned to prove him wrong. He imagined himself surprising everyone one day by kicking off the covers and climbing out of bed all by himself. Nick would whoop and clap, his mother would cry tears of joy, and his doctor would watch in disbelief as AJ walked across the room. “See? I told you I could do it,” he would say before taking a bow.

But that was just a fantasy. In reality, he could do nothing but lie there there and watch Nick shuffle his feet slowly across the tile floor of their room, moving more like a frail old man than a fifteen-year-old boy. “Looking good, Kaos!” AJ told him nonetheless, feeling bad about his little outburst earlier.

Nick gave him an embarrassed sort of grin over his shoulder as he reached the doorway. The nurse stayed two steps behind him, ready to reach out and steady him if he should lose his balance, but AJ knew he would be fine. Nick was stronger than he gave himself credit for. Not many kids could have escaped from a completely submerged vehicle and swum to safety while slowly hemorrhaging from a tear in their intestines, as AJ had reminded him when Nick started beating himself up about not being able to rescue Brian.

“It’s my fault,” Nick had whispered, tears rolling down his cheeks, the only time he had really talked to AJ about the accident and its aftermath. “If I could’ve just gotten him out myself, he wouldn’t have been underwater so long, and maybe he’d be awake by now.”

“It’s not your fault, Nick,” AJ had reassured him. “You did the best you could. If you had stayed down there any longer, you might have drowned, too.” But he understood how helpless Nick felt.

Neither of them had been able to see Brian yet. He was in a different intensive care unit for adult patients, while AJ, despite being just three years younger, was stuck in the pediatric ward with Nick. Thankfully, they both had their mothers there to find out what was going on from the other boys’ families and fill them in. Nick’s mom and Howie’s parents had flown in from Florida, while Kevin’s mother had driven up from Kentucky with Brian’s mom and dad. Denise McLean had been meeting the other mothers every morning for coffee in the hospital cafeteria, which gave them a chance to commiserate and catch each other up on their sons’ conditions. Afterwards, AJ’s mom would come back to his room with an update on how the other boys were doing. He knew that Howie was recovering from his head injury and that Kevin’s broken leg was on the mend, too, but Brian remained in a coma. AJ wished he could visit him, but unlike Nick, no one was letting him get up. Lucky bastard, AJ thought, looking bitterly at Nick’s empty bed.

Nick came back after about ten minutes, looking tired and pale, but pleased with himself. The nurse helped him back into bed and asked both boys if they needed anything before she left to check on her other patients.

“How was it?” AJ asked after she had gone.

Nick shrugged. “Not that bad, actually,” he admitted. AJ couldn’t tell if he was being sincere or just saying what he thought he was supposed to say.

“Glad to hear it.” AJ wanted to be happy for his friend, and he was - but at the same time, he couldn’t help feeling jealous. He watched Nick close his eyes, clearly worn out from his brief workout, and waited for their mothers to come back from breakfast with news about the other boys.

When he heard a knock on the door a few minutes later, he called, “Come in!” As the door swung open wider, he looked up hopefully, expecting to see Denise or Jane. But the pretty, young black woman who walked in was someone he had never met before.

“Hi, I’m Jeanie Boulet,” she introduced herself. “I’m a physical therapist here at the hospital.” He saw her eyes drop from his face to his brace. “And you must be Alexander McLean. Do you go by Alex, or-?”

“AJ,” he said gruffly, glad his mom wasn’t back yet. She didn’t like his new nickname, but he thought AJ sounded a lot cooler than Alex.

“Well, it’s nice to meet you, AJ,” said Jeanie with a warm smile. As she approached his bed, she automatically started to close the curtain behind her, but AJ stopped her.

“You can leave it open,” he said. “He’s my friend; I don’t care if he watches or whatever.” It only seemed fair, after he had seen Nick’s nasty incision that morning.

“Okay,” she agreed, letting it go. “I don’t know if your doctor told you I’d be dropping by today or not, but since it’s been a few days since your surgery, he wants you to get started on a physical therapy regimen.”

AJ perked up at that news. “Really? So are you here to help me walk again?”

Jeanie hesitated for just a second before she replied, “I’m here to help you regain as much function as possible. But first I need to examine you to get a baseline so I know where to begin. Once I have a better idea of the extent of your injury, we’ll be able to set some goals for what you can realistically expect to achieve during the rehabilitation process, and then I’ll design a program to help you get there.”

Despite her positive demeanor, he could tell by her carefully-worded answer that she didn’t want to get his hopes up. He nodded, disappointed but determined to give her a chance. He would do anything to walk again.

“One thing I definitely want to do is help you stay in shape while you’re recovering,” said Jeanie conversationally, as she picked up one of his legs and started peeling off the compression socks they had put to prevent blood clots from forming while he was confined to his bed. “I’ll come by at least once a day and work with you to maintain as much muscle tone and range of motion as you can, especially in your lower body. You’ll need it if you’re going to learn to walk again.”

She caught his eye, and he grinned. “Sounds great. I’ll do whatever it takes.”

Jeanie smiled back. “That’s what I like to hear. I wish all my patients were as cooperative as you.”

“Ha! Hear that, Nick?” AJ smirked at his roommate, who flipped him the middle finger in return. Again, he felt a pang of sorrow inside as he imagined Lou lecturing Nick for making an obscene gesture. A part of him missed those lectures almost as much as he missed Lou’s pep talks.

Setting the pair of compression socks aside, Jeanie said, “I’m going to start by assessing your level of sensation. All you have to do is lie back and let me know what you feel when I touch different parts of your body.”

It turned out to be the same test Dr. Ross had performed on him in the emergency room the day of the accident. Jeanie lowered his bed so that he was lying flat, then had him close his eyes and tell her whether the touches he felt were sharp or dull. Just as before, he felt everything above the waist - the softness of the cotton swab stroking his skin, the sharp prick of the pin poking him - but beyond that, there was no sensation at all.

At least, not until he noticed a bit of light pressure on his left thigh. “I felt that!” he cried, his eyes flying open in surprise.

Jeanie raised her eyebrows. “What did it feel like? Sharp or dull?”

“Dull... I think.”

She showed him the pointy end of the safety pin. “I poked you with this, so it should have been sharp,” she said, “but at least you have some sensation in your leg. That’s better than it was before, when you were first brought in.” She seemed encouraged by these results, and AJ felt a renewed sense of hope.

“Does that mean I might get more feeling back?” he asked.

“You might. You might not. All we know for now is that some of the nerve pathways to your legs are still intact. One signal made it through, and more might follow as you continue to recover.”

It wasn’t much, but it was enough to improve AJ’s mood. By the end of his first physical therapy session, he felt much less miserable. He still couldn’t move his legs or wiggle his toes, but at least he had felt something below the waist. He couldn’t wait to tell his mom when she came back from the cafeteria.

Denise returned to the room around nine o’clock, accompanied by Nick’s mother Jane. As it turned out, they had good news of their own to share.

“Jackie said they’re going to try bringing Brian out of his coma today,” Denise told the two boys. “They’ll take him off the sedatives they’ve been giving him and see if he wakes up.”

“I wanna go see him,” Nick blurted, wincing as he sat up in bed. “Can I, Mom?”

Jane Carter was caught off-guard. “Well, I don’t know, Nick… I guess it depends on what the doctors and nurses say.”

“They’ve been saying I need to get out of bed and move around more,” Nick replied earnestly. “I went for a walk down the hall earlier, but I bet I could make it all the way to Brian’s room.”

AJ stared at him in astonishment. It was like someone had flipped a switch and lit a fire within Nick. The whiny little kid was gone, replaced by a fierce fifteen-year-old who was adamant about seeing his best friend. That was the Nick he knew.

“I wanna go, too,” he added. “I don’t care if it’s in a friggin’ wheelchair - anything to get out of this goddamn bed.”

“Language,” his mother warned, reminding him again of Lou. “We’ll ask your doctor and see what he thinks. If he’ll let you, I’m sure Brian’s family would love for you guys to be there with him.”

AJ and Nick exchanged glances, silently agreeing that they would do whatever it took to go together. Neither of them expressed the worry that was on both of their minds: that the Brian waiting for them might be a much different Brian from the one they had known before the accident. Still, he was their brother, and they wanted to be by his side when he woke up.

If he woke up.

***

Chapter 10

Kevin Richardson felt relieved when the physical therapist came to see him, carrying a pair of crutches. Finally, he thought. After being confined to his bed with his broken leg elevated for the last few days while he finished a course of IV antibiotics, he was looking forward to getting some exercise.

“Hi, I’m Jeanie,” the therapist introduced herself, setting the crutches aside. “I’m here to help you get back on your feet.”

“Hallelujah! Thank God,” said Kevin, who wasn’t used to lying around like this. He had always been active, athletic. The recuperation process was killing him.

Jeanie grinned. “That’s the spirit. Have you ever used crutches before?”

He nodded. “Oh yeah. I played football in high school, so injuries are nothing new. Twisted knee… sprained ankle… but nothing as bad as this,” he replied, looking at his right leg. It was wrapped in a thick brace and propped up on a pillow. Peeking out of the bottom of the brace, his foot still looked puffy compared to the left one.

“Sounds like you’re a pro already,” said Jeanie. She helped Kevin sit up on the edge of his bed, carefully lifting his bad leg off the pillow and lowering it over the side. It felt good to at least get one foot back on the floor. She gave him a robe to put on over his backless hospital gown and wrapped a gait belt around his waist.

Then she picked up the crutches and brought them over to him. “Now, the main thing to remember is not to put any weight on your right leg. The hardware inside is only meant to stabilize the bones until they finish fusing back together, not support your body weight,” she warned him. “You don’t want to risk reinjuring yourself.”

She helped him stand up on his left leg, tucking the crutches underneath his arms. She used a tool to measure the angle of his elbows as he held on to the handgrips and made a few adjustments. “Do those feel okay?” she asked finally, stepping back to study the position of the crutches compared to his body as he stood in place. “We can always adjust the height again if we need to.”

“No, I think they’re fine,” said Kevin, slowly shifting his weight from side to side, testing the stability of the crutches. “Can I try taking a few steps now?”

“Of course,” said Jeanie with a smile. She stood on his right side, slightly behind him, and held on to the gait belt as he swung his bad leg forward, then stepped with his left foot while the crutches supported his weight. “Doing great, Kevin,” she coached him, as he headed toward the door of his room. “Do you want to take a walk down the hall and back?”

Kevin nodded. He knew exactly where he wanted to go, if she would let him. “I wanna walk to my cousin’s room. He’s in the ICU.”

Jeanie’s eyes widened. “Wow… well, that’s a lot farther than I usually have my patients go on the first day.”

“I can do it.” Kevin was adamant. “If you don’t wanna come with me now, I’ll just have my mom take me when we’re done.” His mother had been going back and forth between his room and Brian’s, offering support to her brother and sister-in-law as they stayed at their son’s bedside. She had kept Kevin updated on Brian’s condition; he knew his cousin was finally being weaned off the sedatives that had kept him in a coma for the past three days. Now they were all just anxiously waiting for him to regain consciousness. Kevin wanted to be there when he did.

Jeanie blinked. “Well, all right then. We’ll go to the ICU. But let me know if you get too tired along the way; we can always get you a wheelchair.”

“I’ll be fine,” he insisted, eager to keep moving.

“We need to go down a floor to get to the ICU,” she said, directing him toward the elevator at the end of the hall. By the time they reached it, his arms were already getting tired, but Kevin knew better than to complain. “How are you feeling?” Jeanie asked while they waited for the elevator to arrive.

“Fine,” he fibbed. Truthfully, his whole body was still sore from the accident and weak from lying in bed for the last few days, but he wasn’t going to admit it. He was determined to make it to Brian’s room.

The doors slid open with a ding, and he hauled himself inside. As they descended, he loosened his grip on the crutches and leaned against the wall, giving his arms a little break. Too soon, the elevator reached the next floor, and he repositioned his crutches to keep going.

“Are you sure you don’t want a wheelchair?” Jeanie pressed, as they passed an empty one sitting in the hallway.

The offer was tempting, but Kevin saw it as a sign of weakness and wanted to be strong for Brian. “Nope,” he replied, his arms screaming in pain as he pushed himself on. Each sign on the wall leading them to the ICU became a sort of milestone, another step forward on a long journey. When he finally passed through the doors of the unit, Kevin felt like he was on the last leg, both figuratively and literally.

As he crutched down the hall, focused only on finding Brian’s room, he heard a voice call out, “Hey, where you going, gimp?” He looked up to see AJ waving at him from a wheelchair, a few doors down the hall. Nick was next to him, hanging on to an IV pole and grinning.

Kevin had never been so glad to see the two of them. “Speak for yourself! What are you guys doing here?” he cried happily, hurrying toward them as fast as his crutches would carry him.

“Careful,” Jeanie warned as she jogged alongside him, still hanging on to his gait belt, but Kevin continued as if she hadn’t spoken.

“We came to see Brian,” said Nick, and AJ nodded.

“We couldn’t keep them away,” added Denise, who was pushing her son while Jane Carter walked with hers.

“How are y’all doin’?” Kevin asked as he stopped in front of them, his eyes panning over the two younger boys. Nick looked pale in his patterned hospital gown, one hand held protectively over his stomach. There was a thin tube running into one of his nostrils and an IV in his arm, tethering him to the pole he was wheeling with his other hand. AJ was wearing a bulky back brace and had an IV bag of his own, which was hanging from a shorter pole hooked to the back of his wheelchair. His legs didn’t move beneath the blanket that was draped over his lap.

Nick just shrugged, but AJ smiled. “Better - right, Jeanie?” he replied, raising his eyebrows at the physical therapist.

Kevin turned to look at her, surprised. “You two know each other?”

“We just met earlier today,” said Jeanie, smiling.

“She did a test on my legs, and I actually felt something - for the first time since the accident!” announced AJ, looking elated.

Kevin felt his heart lift with hope. “No kidding? That’s incredible, bro! Way to go!” he congratulated him, balancing on his good leg as he reached out to grasp AJ’s hand. The day just kept getting better and better. Now all they needed was for the fifth member of their group to be all right.

Denise wheeled AJ into Brian and Howie’s room first, followed by Kevin, Jeanie, Nick, and Jane. Kevin found his mother waiting inside with his Uncle Harold and Aunt Jackie, Brian’s parents. Howie’s mom and dad were on the other side of the room with their son. While Howie was awake and happy to see them, Brian was still unconscious, seemingly oblivious to the sudden flutter of activity around him.

As his family and friends all greeted one another, Jackie Littrell glanced up at Nick’s pale face and said, “You look like you could use a seat, sweetheart. Here… take mine.” She rose from the padded chair she had pulled up right next to Brian’s bed and ushered Nick into it. “Thank y’all so much for being here for Brian,” she added, tears sparkling in her blue eyes as she smiled at the others. “We’ll give you boys some time alone with him.” She patted Kevin on the shoulder as she went past him. The other parents took their cue and followed her out, leaving the five boys with the physical therapist.

Jeanie helped Kevin get comfortable in the recliner on Brian’s side of the room, so he could elevate his broken leg. “I’ll be right outside in the hall,” she said once he was settled. “Holler if you need me.”

AJ rolled himself further into the room, parking his wheelchair right between the two beds. “How you doing, D?” he asked Howie.

“Not bad,” replied Howie. His head was still wrapped in gauze, his right eye bruised and swollen, but he looked and sounded a lot better than he had the last time Kevin had seen him in the recovery room after surgery. “I still have headaches and some stiffness in my neck from the whiplash, but all things considered, I think I was pretty lucky. How about you guys?”

AJ repeated his good news, and Nick and Kevin each gave a brief progress report. “What about Brian?” Nick was the first to ask, his eyes focused on his best friend. “Has he woken up at all yet?”

“Hard to say,” answered Howie with a shrug. “His eyes have opened once or twice, just for a few seconds at a time, but he hasn’t really focused on anything or acted like he recognized anyone.”

Kevin frowned, not sure whether this was a good or bad sign. On one hand, the eye-opening suggested Brian wasn’t brain dead, which was a huge relief. But on the other hand, they still didn’t know how much brain damage Brian had sustained. He remembered his mother using the phrase “persistent vegetative state” as she filled him in on what Brian’s doctor had discussed with his parents. It was too soon to diagnose him with the condition, but Kevin knew it was a possibility if he came out of his coma without fully regaining consciousness.

“Yo, Bri,” he called softly, studying his cousin’s face. “Can you hear me, man? We got the whole group here.” He waited hopefully, watching for a positive sign, but there was no response. Lying motionless within a web of tubes and wires, Brian looked almost as lifeless as he had in the emergency room. But at least his color was better, less pallid than it had been before. He still had a breathing tube, but his heart was beating all by itself. Kevin watched its rhythm on the monitor above his bed, reassured by the sight of the line peaking regularly as it snaked across the screen. Yet his blood ran cold when he remembered how long it had been flat. Was he naive to think Brian could wake up with
no permanent disability after being without a heartbeat for more than an hour?

Kevin’s attention was drawn away from Brian when a woman with dark, curly hair came in through the open door. She was wearing cranberry-colored scrubs like the rest of the nurses, but after a moment of deja vu, he realized he recognized her. “Carol?”

Carol smiled. “Hi… Kevin, right? How are you?” She looked around the room, noticing Nick and AJ sitting on either side of Brian’s bed. “The band’s all back together, huh?”

“That’s right,” said Kevin, returning the smile. “What are you doing here? I thought you worked in the emergency room.”

She nodded. “I do, but a couple of nurses called in sick, so I’ve been floated up here for the day.”

“Wow. Paramedic… ER nurse… and now ICU? You really do it all, don’t you?”

Carol laughed. “When you put it that way, I guess I do.” She slipped between Kevin and Nick’s chairs to check on Brian. “It’s good to see you guys again,” she added, as she made a note on his chart.

“Is he getting any better?” Kevin asked, tipping his head toward his cousin.

“He’s stable,” said Carol, studying the monitor. “His numbers are right where we want them to be. We won’t know more until he wakes up.”

“When will that be?”

Leaning over the bed, Carol lifted each of Brian’s eyelids, one by one, and looked into his eyes. “His pupils are becoming more reactive to light, which is a good sign,” she said, as she lowered his lids. “He’s also responding to pain.”

“He’s in pain??” Nick blurted, his mouth dropping open in an expression of outrage. “Why aren’t you giving him pain medicine?!”

“No, I don’t mean that kind of pain,” Carol replied calmly. “Let me show you.”

She made a fist and rubbed her knuckles roughly over Brian’s breastbone. He writhed away in response, his brow creasing as a frown formed on his face, and pulled his arms up toward his chest as if to push her hands away. His eyelids fluttered, but didn’t fully open, and once Carol removed her hand, his body began to relax again, his hands falling back to his sides. The wrinkles in his forehead smoothed out as his face returned to its former blank expression.

“When I saw him the day of the accident, he wasn’t doing that. He wasn’t reacting at all,” said Carol. “The fact that he’s able to feel and respond to painful stimuli shows that his brain is still functioning on some level. That’s why we test for that. Otherwise, we’ve been keeping him comfortable.”

Kevin hated to see his cousin in any kind of pain, but he felt encouraged by Carol’s explanation. “Is there anything else we can do to help him wake up without hurting him?” he wondered.

“Talk to him,” she said simply. “Touch him. Squeeze his hand. Stroke his hair. Let him know you’re here. It may not help, but it won’t hurt.”

AJ rolled himself closer to Brian’s bed and reached for his right hand. “Hey, Rok,” he said, squeezing it in his. “Bone here. You ready to wake up, bro?”

On the other side of the bed, Nick laced his fingers through Brian’s. “C’mon, Frick,” he added, rubbing the back of Brian’s left hand with his thumb. “Quit bein’ lazy. Just open your eyes and look at me.”

AJ laughed at Nick’s words, but Kevin didn’t understand why. His recliner was too far away from the bed for him to reach out and touch Brian, but he kept his eyes focused on his cousin’s face, curious to see if he would respond to their voices. Without really thinking, he started softly singing, “We-e-e’ve been waiting so long, just can’t hold it back no more…”

To his astonishment, he saw Brian’s brow furrow again, and he abruptly stopped singing. “Did y’all see that??”

“Yeah… he doesn’t want you stealing his solo!” said AJ with a loud cackle. “Right, Rok? C’mon, dude, wake up and tell your cousin to knock it off!”

Brian’s eyelids fluttered. They all leaned forward, watching with anticipation. Nick and AJ clutched both of Brian’s hands, as Howie and Kevin whispered words of encouragement. “Come on, Brian… You can do it…”

They could tell he was listening. His eyebrows wiggled as he worked to lift his lids. Finally, his wispy lashes rose to reveal two slits of blue.

“That’s it, cous,” Kevin whispered through the lump that had risen in his throat when he found himself looking into those familiar eyes. Brian’s face became slightly blurred as his own eyes filled with tears.

Nick was beaming from ear to ear. “Welcome back, bro,” he said, gripping Brian’s hand tightly. As the other guys watched, Brian’s unfocused eyes suddenly found Nick’s and locked onto them like tractor beams. His fingers brushed against his best friend’s, giving Nick’s hand a weak squeeze back.

“Did you see what he did?!” Nick gasped. “He squeezed my hand! He knows who I am!”

They all nodded. Kevin was wiping away tears. Nurse Carol glanced up from her notes, smiling when she saw that Brian’s eyes were open. “Want me to go get his parents?” she asked.

“In a minute,” replied Kevin. “Let us talk to him first.” He couldn’t stand sitting back in the recliner, unable to reach Brian, so he lowered the footrest, found his crutches, and hauled himself painfully to his feet. He hobbled forward and stood by the head of Brian’s bed, balancing on his left leg. “Hey, Bri,” he said softly, brushing the hair back from Brian’s forehead the way his mother would have.

Brian frowned, a fog of confusion filling his eyes as they shifted slowly toward Kevin.

“You’re in the hospital,” Kevin continued, trying to clarify things for him. “Do you remember what happened? Blink once for yes or twice for no.”

After a pause, Brian’s eyes closed and opened again once… twice.

Kevin nodded, swallowing hard as the lump in his throat returned. “We were in an accident,” he said hoarsely, still stroking his cousin’s hair. “But Nick and AJ and Howie and me… we’re all right. And you’re gonna be all right, too.”

He looked around the room, fresh tears welling in his eyes as they took in the four faces of his bandmates, his brothers. Howie, whose good eye was gleaming with moisture. AJ, who was nodding as he grasped Brian’s hand. Nick, who couldn’t stop grinning. And Brian, who blinked again - just once this time - without taking his eyes off his cousin.

Kevin smiled down at him. “Yup,” he agreed, feeling more hopeful than he had in days. “The five of us are gonna be just fine.”

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