“But you wanted it to.”

The silence that followed was an answer more honest than anything Elaine could have said. Maura remained silent and still, an uncomfortable witness to this painful confession. Arlo had to know his time was running out. This would be his last chance to hear the truth.

“Doesn’t matter.” He sighed. “Not now.”

“But it does matter,” said Elaine.

“Still love you.” Arlo closed his eyes. “Want you… to know that.”

Elaine put her hand over her mouth to smother her sob. The first light of dawn lit the window, washing her in its glow as she knelt beside him, racked by grief and guilt. She took in a shuddering breath and straightened. Only then did she notice that Maura was awake and watching them, and she turned away, embarrassed.

For a moment, the two women did not speak. The only sound was Arlo’s hoarse breathing, in and out, in and out, through rattling clots of phlegm. Even from across the room, Maura could see that his face had changed, his eyes more sunken, his skin now tinged with a sickly green cast. She did not want to look at his leg, but there was enough light now to examine it, and she knew she should. This was her responsibility, a responsibility that she wanted no part of, but she was the doctor. Yet all her medical training had turned out to be useless without modern drugs and clean surgical instruments and the icy determination to do what was necessary: to cut off a screaming man’s leg. Because that was what needed to be done. She knew it even before she exposed the limb, before she smelled the stink of what festered beneath the blanket.

“Oh God,” Elaine groaned, and stumbled away. Maura heard the front door swing shut as Elaine escaped the fetid room in search of fresh air.

It has to be done today, thought Maura, staring down at the putrefying leg. But she couldn’t do it alone; she needed Elaine and Grace to hold him down, or she’d never be able to control the bleeding. She glanced at the girl, who was still sound asleep on the sofa. Could she count on Grace? Did Elaine have the fortitude to hold firm despite the screaming and the pitiless rasp of the saw? If they buckled, Maura could end up killing him.

She pulled on her jacket and gloves and stepped outside. She found Elaine standing on the porch, drawing in deep breaths of cold air, as though to wash the stink of Arlo’s rotting body from her lungs.

“How long do you think he has?” Elaine asked softly.

“I don’t want to talk about countdowns, Elaine.”

“But he’s dying. Isn’t he?”

“If nothing is done.”

“You and Doug already did something. It didn’t help.”

“So we have to take the next step.”

“What?”

“Amputation.”

Elaine turned and stared at her. “You can’t be serious.”

“We’re left with no other choice. We’ve gone through all the antibiotics. If that leg stays on, he’ll die of septic shock.”

“You were the one who didn’t want to do surgery before! Doug had to talk you into it.”

“Things have gotten a lot worse. Now it’s not his leg we want to save. It’s his life. I need you to hold him down.”

“I can’t do it by myself!”

“Grace will have to help.”

“Grace?” Elaine snorted. “You think you can trust that spoiled brat to be useful for anything?”

“If we explain it to her. If we tell her how important this is.”

“I know her better than you do, Maura. She’s got Doug completely under her control, and he’ll do anything for his little princess. It’s all about keeping her happy, about making up for the fact her mother walked out.”

“You don’t give her enough credit. She may be just a kid, but she’s smart. She’ll understand what’s at stake here.”

“She doesn’t care. Don’t you get that about her? She doesn’t fucking care about anyone but herself.” Elaine shook her head. “Don’t count on Grace.”

Maura released a breath. “If you’re the only one who’ll help me, then we’ll need rope. Something to tie him down on the table.”

“You really plan to go through with it?”

“What would you have me do? Stand by and watch him die?”

“They could come for us today. They could be here in just a few hours.”

“Elaine, we need to be realistic.”

“Another day won’t make a difference, will it? If they show up tomorrow, it will be soon enough.”

“Doug’s been gone for two days. Something’s gone wrong.” She paused, reluctant to admit the obvious. “I don’t think he made it,” she said quietly. “I think we’re on our own.”

Elaine’s eyes suddenly glistened with tears, and she turned and stared at the snow. “And if you do it? If you cut off his leg, what are the chances he’ll die anyway?”

“Without antibiotics, I’m afraid his chances aren’t good. No matter what we do.”

“Then why put him through it? If he’s going to die no matter what, why torture him?”

“Because I don’t have any other tricks in my bag, Elaine. It’s down to this, or just give up.”

“Doug could still send help-”

“It should’ve come already.”

“You need to give him time.”

“How long do we have to wait before you accept the obvious? Help isn’t coming.”

“I don’t care how long it takes! Jesus Christ, do you even hear what you’re saying? Are you serious, cut off his fucking leg?” Elaine suddenly sagged against the porch post, as though too weary to support her own weight. “I won’t help you do it,” she said softly. “I’m sorry.”

Maura turned and looked at the road leading out of the valley. It was another brilliantly clear day, and she squinted at the glare of the morning sunlight on the snow. We have one last option, she thought. If she didn’t take it, Arlo would die. Maybe not today, maybe not even tomorrow, but in that room, she could smell the inevitability of what was to come, unless she acted.

“You have to keep him hydrated,” she said. “As long as he’s awake enough to drink, keep feeding him sips of sugar water. And food, if he’s able. All we’ve got left for the pain is Tylenol, but we’ve got plenty of that.”

Elaine frowned at her. “Why are you telling me this?”

“Because you’re now in charge. Just keep him comfortable; that’s the best you can do.”

“What about you?”

“My cross-country skis are still up on the Suburban. I’ll pack some overnight gear in case I don’t make it out before dark.”

“You’re going to try skiing down the mountain?”

“Would you rather be the one to do it?”

“If Doug couldn’t make it-”

“He may have had an accident. He may be lying somewhere with a broken leg. In which case, it’s even more important that I get started now, while I’ve still got a full day ahead.”

“What if you don’t come back, either?” Elaine asked, desperation in her voice.

“You have plenty of food and firewood. You and Grace could hang on here for months.” She turned.

“Wait. I need to tell you something.”

Maura paused on the porch and looked back. “Yes?”

“Doug and I, we were never together.”

“I heard you tell Arlo.”

“It’s the truth.”

“Why does it matter?”

“I thought you’d want to know.”

“To be honest, Elaine, what happened or didn’t happen between you and Doug makes absolutely no difference to me.” Maura turned toward the house. “All I care about right now is getting all of us out of this place alive.”

IT TOOK HER an hour to fill a backpack. She stuffed it with food and extra socks and gloves and a sweater. From the garage, she was able to scavenge a tarp and sleeping bag, items she hoped she wouldn’t need. With any luck, she could be down the mountain by nightfall. Her cell phone battery had drained to nothing, so she left it in Elaine’s care, along with her purse, and packed only cash and ID. On a thirty-mile journey, there was no room for even one unnecessary ounce.

Even so, the pack weighed heavily on her shoulders as she started up the valley road. Every step took her past reminders of their earlier ill-fated attempt to leave. Here were the rutted tracks left by the Jeep as it had struggled to climb through the snow. Here were the footprints they’d left after they’d abandoned the stranded vehicle and walked back down, dragging Arlo on the sled. Another hundred yards, another few hairpin turns, and she began spotting Arlo’s blood on the snow, tracked down the road on their boots. Another turn of the road, and there was the stranded Jeep with the broken tire chain. And more blood.