His sobs, unstoppable now, broke from deep within him, like retching, and racked him from head to toe. “Oh, God, please no” he cried, his mind hurtling between praying for a miracle and knowing she was dead.

With one hand he grabbed on to the chain that dangled from her heels into the water. At its lower end, a few feet under the surface, he felt the anchor they’d used as a weight and knelt on its flanges, bringing his head level to hers. With his free arm he clutched her to him. The meaty horror of what he held blasted all rational thought out of his brain, and his thinking collapsed in on itself like an imploding star. Yet a fragment of him still rebelled, refused against all logic to accept the clammy reality in his arms. He summoned enough of his training to slip his fingertips along the side of her neck and push them into skin that had the consistency of cold Plasticine. The vessels within lay lifeless as he counted off the seconds. Just hours earlier he’d felt them pump with excitement as he’d explored every dimple and depression of her with his mouth.

He slammed his fist into the middle of her chest three times, then palpated over the carotid again. Sometimes the impact of a “chest thump” could restart a fibrillating heart.

He knew it to be a useless gesture, but had to try. The desperate ploy extended hope by a few more seconds and kept him in a universe where she might be alive just a little longer.

He’d reached twelve when he felt a solitary impulse.

Could his mind have imagined the absent beat? Perhaps it had been a twitch or throb of an artery in his own finger.

He swallowed his cries, stilled his breathing, and waited, once again counting seconds, the spaces between each number stretching to an eternity.

Another beat.

He waited for a third.

Again a sluggish rise pushed up against his fingers.

Instantly he had his lips on hers. They felt like wet clay, but he molded his to form a seal, and blew. The resistance of her lungs made air squeak out the side of his mouth, but he saw her chest rise. As he continued to give her breaths, he mentally ticked off everything he could remember about hypothermia.

People had survived up to an hour submerged in ice water. He’d no idea how long she’d been under.

That she’d recovered a pulse at all was better than a full-out cardiac arrest. The slow rate might even be protective, reducing her heart’s oxygen requirements. And cold could lower the metabolism of her other vital organs so that they might survive the subsequent reduction in blood flow. As for her lungs, her airway ought to have protected them from filling with water, seizing shut at the first influx of liquid, the same reflex that kept fluid out of the lungs in the womb.

His mind raced, dredging up every hopeful scrap he could summon, then clung to the science of it. His teeth chattered, and he shook with such force that all his muscles, including those in his vocal cords, snapped into spasm. Each time he exhaled into her lungs, a plaintive, tremulous moan issued from his throat, the mournful sound filling her chest, then echoing toward the pale, barely visible opening above their heads. He listened for the staccato noise of helicopter blades or the wail of police sirens over his own pathetic keening, but to no avail.

Yet he continued to deliver air to her, puff after puff, settling into the rhythm despite being half-submerged and clinging to the chains with one hand, supporting her head with the other, all the while precariously perched on the anchor.

He paused between breaths to quickly shine his beam of light into her pupils. From the middle of her deathlike stare came a slow sluggish constriction. Yes! She still had life in her brain.

He even went so far as to lay out a treatment plan for when the air ambulance arrived: Intubate and ventilate her. Slowly warm her body core with heated oxygen and warm IVs. Raise her temperature no more than two degrees Fahrenheit an hour as per protocol. Visualizing this ritual made it seem closer at hand. And at the hospital, if need be, they could even put her on a heart-lung machine to warm her blood directly.

I can bring her back, he told himself. She can survive this.

Such were the mental games he played to keep despair at bay and blot out his more objective clinical voice that told him nothing would work.

And I’ll protect her from overeager residents, he continued in the same vein, filling his mind with anything to avoid thinking she was finished.

Keep them from loading her up with adrenaline and atropine, that’ll be the trick – He stopped in midthought.

The water crept up his chest, and the top of her head edged closer to the surface.

They were sinking.

Their weight was stretching the nylon rope.

His panic surged.

Within seconds he felt the icy water at his neck and watched it inch past her hairline toward her eyes.

He got off his knees and crouched on the flanges, then pulled her to him, trying to bend her at the waist so her back was on his lap and she’d be faceup. That way he could keep her head above water and still give her mouth-to-mouth ventilation. He moved her into position, but her entire body, already stiff with cold, wouldn’t flex properly. When he bent down to deliver another lungful of air, the waterline lapped over her face.

Where was Dan?

What if the pilots couldn’t fly because of the storm, or took too long, or couldn’t find this godforsaken place?

Rapidly losing strength, his teeth chattered so fiercely now that they clicked against hers. He tried to recall what his textbooks said about survival times in frigid water as far as staying conscious, but his memory no longer functioned that well, a sign that his body heat was quickly dropping.

Choking, he pulled her higher onto his thighs.

Again he scanned the pale circle and strained to hear the sounds of rotors or approaching sirens.

Nothing – only smaller circles of snow reeling and floating in total silence.

Come soon, he prayed, and filled her lungs yet again.

The ghostly opening peered down on them, offering no more hope than a malevolent, empty eye.

5:15 A.M.

New York City Hospital

Earl had to escape. The one person he couldn’t defend himself against was Melanie Collins.

He tried to call Janet. If anything happened to him, he wanted someone to know the truth. But he found his phone line dead.

He immediately summoned his nurse.

“Dr. Collins’s latest orders are for complete rest,” Mrs. White, his cherry-cheeked angel informed him, delivering the news with an emphatic stare over the top of her tiny square-rimmed spectacles. “She phoned at midnight to check how you were doing. When she learned you’d been making late-night calls and complaining about palpitations, she read the riot act. No ingoing or outgoing communications, period.”

“Now wait a minute-”

“Told us she’d put you out and intubate you if she had to, just so you’d get some rest.”

“No way!”

“Talk it over with her. She’ll be here at seven for morning rounds – you can set your clock by her.”

She turned to leave.

And if he told this red-cheeked minder that Melanie Collins might be trying to kill him?

What makes you think a crazy thing like that? she would ask.

Because Melanie Collins may have killed Kelly McShane.

And why would she have done such a thing?

Because as Melanie basked in the adulation she garnered for nailing hard-to-diagnose illnesses, Kelly must have sensed the same all-about-me afterglow she’d seen her mother exude when people gushed over her for taking care of Kelly’s mysterious diseases.

“So?”

So Kelly realized Melanie made patients sick for the purpose of playing the hero later.