Stepping to her side, Earl asked, “What have we got?”

She hooked her patient to a bag of saline and thumbed the valve wide open. “Bleeding from both ends – coffee grounds up top, both black tarry stool and bright red blood by rectum. Vitals, ninety over sixty and pulse one-ten.”

“Coffee grounds” meant blood turned dark brown by stomach acids. “Tarry stools” indicated blood also originating in the stomach, but rendered black by those same acids during their longer passage through the intestines. “Bright red blood” meant either a second source of bleeding below the stomach, which was unlikely, or that the hemorrhage was so severe the blood ran through the gut too fast for the digestive juices to work the color change. Bottom line, the man would soon slip into shock. “Name?” he asked.

“Dr. Garnet, meet Mr. Brady,” she said, the worry in her eyes belying her reassuring smile.

“Hi, Doc.”

“Well, Mr. Brady, looks like I’m your host, and you are our VIP patient this morning. Hang on. We’re going for a ride. Don’t worry, J.S. here and I just passed stretcher-driving school.”

Together they rushed him down the hall to a resuscitation room, picking up help on the way. Earl kept up the banter so everyone would stay loose.

“How many metal detectors did your nose set off today, J.S.?”

“Hey, I’m a one-woman security check. You should pay me extra.” They skidded to a stop, and she immediately started to secure another IV line, this one in the groin.

“Okay, people, listen up,” said Earl. “Who’s got the head? Who’s on the tail? We need full monitoring, bloods, type and cross for six units, and hang up two of O-negative stat.”

“Tails,” an orderly said.

“Heads!” called a tall, model-thin woman with a boyish haircut as she pushed through to the table and applied oxygen prongs to the man’s nose. Her name tag read SUSANNE ROBERTS, NURSING DIRECTOR. “Morning, Dr. Garnet.”

“Glad to see you here, Susanne.”

“What happened? You were late at being early this morning.” She’d been director of nursing for as long as he’d been chief, and knew his routine as well as her own.

“Breakfast with Brendan.” Gloving up, he swabbed Mr. Brady below the right collarbone.

“With competition like that, we’re lucky to see you at all.” She ripped the wrapper off a coiled green catheter, anointed one end with a glob of sterile jelly, and stood ready to pass it down the back of Mr. Brady’s throat into his stomach, but through a nostril.

“Don’t worry. The nanny always throws me out by seven-twenty-five.” He draped a sterile towel over their patient’s chest and explained as he worked. “Now I’m injecting a bit of freezing, and then we’ll put a central line through the vein under your clavicle to better replace the volume of blood you lost with normal saline.”

A young medical student hastily joined him, obviously eager to try the procedure. Seconds later, under Earl’s expert guidance, the boy announced, “I’ve got it!” sounding surprised at his success. He looked up, beaming proudly, and promptly broke sterile technique as he shoved a shock of curly red hair out of his eyes.

“Good show,” Earl said. “Now change your gloves!”

The orderly who had taken tails was draining the contents of the bladder through a tube to a transparent collecting bag marked for measuring output. A reassuring grin spread across his ebony face. “Your kidneys are working fine, Mr. Brady.”

“Bloods drawn and gone for type and cross,” Susanne said at Earl’s ear, still waiting to pass her tube, “and GI’s been called to scope him.”

J.S. connected her needlework to one of the overhanging bags of blood. “Femoral line’s in,” she said, her tone breezily calm.

“Still the best hands in the business,” Earl told her as he stepped to the counter and scribbled medication orders.

Susanne moved in with the tube.

One of her older colleagues, a speedy, gray-haired woman who wore colorful leg warmers and Reeboks, stepped up to help her. “Now you just swallow this down, Mr. Brady…”

Other voices reported.

“… monitors on; patient wired…”

“… BP and pulse holding…”

Earl relaxed a notch as he always did once a patient was lined and they were ready for any sudden nasty turns for the worse. He glanced up at the clock. “Wow! Congratulations, everyone. A hundred-and-fifteen-point-five seconds. My buy at the next party.” He gave the dazed-looking Mr. Brady a reassuring pat on the arm. “You’re invited, too, sir, except I’m afraid you’ll be drinking milk shakes.”

Once Susanne and he were out in the hallway, he asked, “Any other surprises to start the day?”

“None. You still got fifteen minutes until rounds. If you promise to be good, I’ll give you my copy of the New York Herald, let you use our cappuccino machine, and not disturb you until eight.”

“Susanne, I love you.”

“Watch it, or I’ll tell Janet.”

“Hey, she knows I go gaga over anyone who offers me a cappuccino, a Herald, and the time to savor them.”

Turning back toward triage, she said, “You just used up fifteen of your seconds.”

Behind the closed door of his office – a spartan shoe box painted institutional green – he put his feet up on a hospital-issue gray metal desk, leaned back in the high-backed, maroon Naugahyde-covered chair that came with it, and savored the first sip of a cinnamon-tinged coffee. Some days it was great to be chief.

He felt at the top of his game. Fifty years old, lean in body and mind, he could withstand the physical rigors of emergency better than any of the Young Turks, and very few of the veterans could match him mentally. Susanne once told him her nurses had nicknamed him “The Thief” because of all the times he reached right up to the pearly gates and robbed Saint Peter of a soul already settled in for a grilling from the book of deeds. Even the departmental chaplains, she said, admitted that both God and the devil had to get up early if they wanted to beat Garnet to the punch.

He smiled at the recollection, having learned long ago not to take what people said about him too seriously. He knew his talent – the ability to read an unfolding ER scenario three steps ahead of trouble and jump-start his team accordingly. “Proactive” the more youthful members of his staff called it. “Goddamn teaching” was the term he used. Those who couldn’t keep up, especially the administrators, had less-kind words. But they were the first to seek him out when a child, spouse, sibling, or parent was gravely ill, and a life was on the line.

He opened the paper. Page one gave the latest details about the interminable war on terror. Yet another Homeland Security alert took up most of page two. At the bottom were adds with pouty-looking boys modeling tuxedos for sale. Real men mustn’t be a worthwhile consumer group anymore, he mused, savoring yet another sip of coffee. Then he read the lead story on page three.

Skeletal remains found fifteen days ago in Trout Lake, adjacent to the idyllic resort community of Hampton Junction, twenty miles north of Saratoga Springs, have been identified as those of a socially prominent fourth-year medical student who disappeared over twenty-seven years ago. Retrieval of the remains was a protracted affair requiring a special team of forensic divers to sift through mud at great depth in cold temperatures. Dental records and preliminary DNA results based on a lock of the victim’s hair established that she was Kelly McShane Braden, twenty-nine years old at the time of her disappearance and the wife of Charles Braden IV, currently Chief of Cardiology at New York City Hospital.

According to Hampton Junction coroner, Dr. Mark Roper, Ms. Braden was the victim of foul play. “A fracture of her skull indicates she sustained a blow to the head prior to going in the water. Whether she died of head trauma or drowning is impossible to distinguish,” he said yesterday, when results of his examination and testing were announced. Sheriff Dan Evans confirmed that heavy items found on and near the bones of her legs suggest her body was weighted and bound when disposed of in the deepest waters of the lake.