Red Hill

Chapter One

Scarlet

MY CHEST HEAVED AS THE thick metal door closed loudly behind me. I held out my arms to each side, letting water drip off my fingertips onto the white tile floor. My once royal-blue scrubs were now navy, heavily saturated with cold rainwater.

A squashing sound came from my sneakers when I took a step. Ick. Not much was worse than wet clothes and shoes, and it felt like I’d jumped into a swimming pool fully dressed. Even my panties were wet. We were only a few days into spring, and a cold front had come through. The rain felt like flying death spikes of ice.

Flying death spikes. Snort. Jenna’s dramatic way of describing things was obviously rubbing off on me.

I slid my name badge through the card reader and waited until the small light at the top turned green and a high-pitched beep sounded, accompanied by the loud click of the lock release. I had to use all of my body weight to pull open the heavy door, and then I stepped into the main hallway.

Fellow coworkers flashed me understanding smiles that helped to relieve some of my humiliation. It was obvious who all had just arrived on shift, about the time the sky opened up and pissed on us.

Two steps at a time, I climbed the stairs to the surgical floor and snuck into the women’s locker room, stripping down and changing into a pair of light-blue surgery scrubs. I held my sneakers under the hand dryer, but only for a few seconds. The other X-ray techs were waiting for me downstairs. We had an upper GI/small bowel follow-through at 8:00, and this week’s radiologist was more than just a little grumpy when we made him run behind.

Sneakers still squishing, I rushed down the steps and back down the main hallway to Radiology, passing the ER double doors on my way. Chase, the security guard, waved at me as I passed.

“Hey, Scarlet,” he said with a small, shy smile.

I only nodded, more concerned with getting the upper GI ready on time than with chitchat.

“You should talk to him,” Christy said. She nodded in Chase’s direction as I breezed by her and her piles of long, yellow ringlets.

I shook my head, walking into the exam room. The familiar sound of my feet sticking to the floor began an equally familiar beat. Whatever they cleaned the floor with was supposed to sanitize the worst bacteria known to man, but it left behind a sticky residue. Maybe to remind us it was there—or that the floor needed to be mopped again. I pulled bottles of barium contrast from the upper cabinet, and filled the remaining space with water. I replaced the cap, and then shook the bottle to mix the powder and water into a disgusting, slimy paste that smelled of bananas. “Don’t start. I’ve already told you no. He looks fifteen.”

“He’s twenty-seven, and don’t be a shrew. He’s cute, and he’s dying for you to talk to him.”

Her mischievous smile was infuriatingly contagious. “He’s a kid,” I said. “Go get the patient.”

Christy smiled and left the room, and I made a mental note of everything I’d set on the table for Dr. Hayes. God, he was cranky; particularly on Mondays, and even more so during shitty weather.

I was lucky enough to be somewhat on his good side. As a student, I had cleaned houses for the radiologists. It earned me decent money, and was perfect since I was in school forty hours a week at that time. The docs were hard asses in the hospital, but they helped me out more than anyone else while I was going through the divorce, letting me bring the girls to work, and giving me a little extra at Christmas and on birthdays.

Dr. Hayes paid me well to drive to his escape from the city, Red Hill Ranch, an hour and a half away in the middle-of-nowhere Kansas to clean his old farmhouse. It was a long drive, but it served its purpose: No cell service. No Internet. No traffic. No neighbors.

Finding the place on my own took a few tries until Halle made up a song with the directions. I could hear her tiny voice in my head, singing loudly and sweetly out the window.

West on Highway 11

On our way to heaven

North on Highway 123

123? 123!

Cross the border

That’s an order!

Left at the white tower

So Mom can clean the doctor’s shower

Left at the cemetery

Creepy . . . and scary!

First right!

That’s right!

Red! Hill! Roooooooad!

After that, we could make it there, rain or shine. I’d even mentioned a few times that it would be the perfect hideaway in case of an apocalypse. Jenna and I were sort of post-apocalyptic junkies, always watching end-of-the-world marathons and preparation television shows. We never canned chicken or built an underground tank in the woods, but it was entertaining to see the lengths other people went to.

Dr. Hayes’s ranch would make the safest place to survive. The cupboards and pantry were always stocked with food, and the basement would make any gun enthusiast proud. The gentle hills kept the farmhouse somewhat inconspicuous, and wheat fields bordered three sides. The road was about fifty yards from the north side of the house, and on the other side of the red dirt was another wheat field. Other than the large maple tree in the back, visibility was excellent. Good for watching sunsets, bad for anyone trying to sneak in undetected.

Christy opened the door and waited for the patient to enter. The young woman stepped just inside the door, thin, her eyes sunken and tired. She looked at least twenty pounds underweight.

“This is Dana Marks, date of birth twelve, nine, eighty-nine. Agreed?” Christy asked, turning to Dana.

Dana nodded, the thin skin on her neck stretching over her tendons as she did so. Her skin was a sickly gray, highlighting the purple under her eyes.

Christy handed the woman loose folds of thin blue fabric. “Just take this gown behind the curtain there, and undress down to your underpants. They don’t have any rhinestones or anything, do they?”

Dana shook her head, seeming slightly amused, and then slowly made her way behind the curtain.

Christy picked up a film and walked to the X-ray table in the middle of the room, sliding it into the Bucky tray between the table surface and the controls. “You should at least say hi.”

“Hi.”

“Not me, dummy. To Chase.”

“Are we still talking about him?”

Christy rolled her eyes. “Yes. He’s cute, has a good job, has never been married, no kids. Did I mention cute? All that dark hair . . . and his eyes!”

“They’re brown. Go ahead. I dare you to play up brown.”

“They’re not just brown. They’re like a golden honey brown. You better jump on that now before you miss your chance. Do you know how many single women in this hospital are salivating over that?”

“I’m not worried about it.”

Christy smiled and shook her head, and then her expression changed once her pager went off. She pulled it from her waistline and glanced down. “Crap. I have to move the C-arm from OR 2 for Dr. Pollard’s case. Hey, I might have to leave a little early to take Kate to the orthodontist. Do you think you could do my three o’clock surgery? It’s easy peasy.”

“What is it?”

“Just a port. Basically C-arm babysitting.”

The C-arm, named for its shape, showed the doctors where they were in the body in real time. Because the machine emitted radiation, it was our jobs as X-ray techs to stand there, push, pull, and push the button during surgery. That, and make sure the doctor didn’t over-radiate the patient. I didn’t mind running it, but the damn thing was heavy. Christy would have done the same for me, though, so I nodded. “Sure. Just give me the pager before you leave.”

Christy grabbed a lead apron, and then left me to go upstairs. “You’re awesome. I wrote Dana’s history on the requisition sheet. See you later! Get Chase’s number!”

Dana walked slowly from the bathroom, and I gestured for her to sit in a chair beside the table.

“Did your doctor explain this procedure to you?”

Dana shook her head. “Not really.”

A few choice words crossed my mind. How a doctor could send a patient in for a procedure without an explanation was beyond me, and how a patient couldn’t ask wasn’t something I understood, either.

“I’ll take a few X-rays of your abdomen, and then fetch the doctor. I’ll come back, make the table vertical, and you’ll stand and drink that cup of barium,” I said, pointing to the cup behind me on the counter, “a sip at a time, at the doctor’s discretion. He’ll use fluoroscopy to watch the barium travel down your esophagus and into your stomach. Fluoro is basically an X-ray, but instead of a picture, we get a video in real time. When that’s done, we’ll start the small bowel follow-through. You’ll drink the rest of the barium, and we’ll take X-rays as it flows through your small bowel.”

Dana eyed the cup. “Does it taste bad? I’ve been vomiting a lot. I can’t keep anything down.”

The requisition page with Christy’s scribbles was lying on the counter next to the empty cups. I picked it up, looking for the answer to my next question. Dana had only been ill for two days. I glanced up at her, noting her appearance.

“Have you been sick like this before?” She shook her head in answer. “Traveled recently?” She shook her head again. “Any history of Crohn’s disease? Anorexia? Bulimia?” I asked.

She held out her arm, palm up. There was a perfect bite mark in the middle of her forearm. Each tooth had broken the skin. Deep, red perforations dotted her arm in mirrored half-moons, but the bruised skin around the bites was still intact.

I met her eyes. “Dog?”

“A drunk,” she said with a weak laugh. “I was at a party Tuesday night. We had just left, and some asshole wandering around outside just grabbed my arm and took a bite. He might have pulled a whole chunk off if my boyfriend hadn’t hit him. Knocked him out long enough for us to find the car and leave. I saw on the news yesterday that he’d attacked other people, too. It was the same night, and the same apartment complex. Had to be him.” She let her arm fall to her side, seeming exhausted. “Joey’s in the waiting room . . . scared to death I have rabies. He just got back from his last tour in Afghanistan. He’s seen everything, but he can’t stand to hear me throw up.” She laughed quietly to herself.

I offered a comforting smile. “Sounds like a keeper. Just hop up on the table there, and lay on your back.”

Dana did as I asked, but needed assistance. Her bony hands were like ice.

“How much weight did you say you’ve lost?” I asked while situating her on the table, sure I had read Christy’s history report wrong on the requisition.

Dana winced from the cold, hard table pressing against her pelvic bone and spine.

“Blanket?” I asked, already pulling the thick, white cotton from the warmer.

“Please.” Dana hummed as I draped the blanket over her. “Thank you so much. I just can’t seem to get warm.”

“Abdominal pain?”

“Yes. A lot.”

“Pounds lost?”

“Almost twenty.”

“Since Tuesday?”

Dana raised her brows. “Believe me, I know. Especially since I was thin to begin with. You . . . don’t think it’s rabies . . . do you?” She tried to laugh off her remark, but I could hear the worry in her voice.

I smiled. “They don’t send you in for an upper GI if they think it’s rabies.”

Dana sighed and looked at the ceiling. “Thank God.”

Once I positioned Dana, centered the X-ray tube, and set my technique, I pressed the button and then took the film to the reader. My eyes were glued to the monitor, curious if she had a bowel obstruction, or if a foreign body was present.

“Whatcha got there, buddy?” David asked, standing behind me.

“Not sure. She’s lost twenty pounds in two days.”

“No way.”

“Way.”

“Poor kid,” he said, genuine sympathy in his voice.

David watched with me as the image illuminated the screen. When Dana’s abdomen film filled the screen, David and I both stared at it in shock.

David touched his fingers to his mouth. “No way.”

I nodded slowly. “Way.”

David shook his head. “I’ve never seen that. I mean, in a textbook, yes, but . . . man. Bad deal.”

The image on the monitor was hypnotizing. I’d never seen someone present with that gas pattern, either. I couldn’t even remember seeing it in a textbook.

“They’ve been talking a lot on the radio this morning about that virus in Germany. They say it’s spreading all over. It looks like war on the television. People panicking in the streets. Scary stuff.”

I frowned. “I heard that when I dropped off the girls this morning.”

“You don’t think the patient has it, do you? They’re not really saying exactly what it is, but that,” he said, gesturing to the monitor, “is impossible.”

“You know as well as I do that we see new stuff all the time.”

David stared at the image for a few seconds more, and then nodded, snapping out of his deep thought. “Hayes is ready when you are.”

I grabbed a lead apron, slid my arms through the armholes, and then fastened the tie behind my back as I walked to the reading room to fetch Dr. Hayes.

As expected, he was sitting in his chair in front of his monitor in the dark, speaking quietly into his dictation mic. I waited patiently just outside the doorway for him to finish, and then he looked up at me.

“Dana Marks, twenty-three years old, presenting with abdominal pain and significant weight loss since Wednesday. Some hair loss. No history of abdominal disease or heart problems, no previous abdominal surgeries, no previous abdominal exams.”

Dr. Hayes pulled up the image I’d just taken, and squinted his eyes for a moment. “How significant?”

“Nineteen pounds.”

He looked only slightly impressed until the image appeared on the screen. He blanched. “Oh my God.”

“I know.”

“Where has she been?”

“She hasn’t traveled recently, if that’s what you mean. She did mention being attacked by a drunk after a party Tuesday night.”

“This is profound. Do you see the ring of gas here?” he asked, pointing to the screen. His eyes brightened with recognition. “Portal venous gas. Look at the biliary tree outline. Remarkable.” Dr. Hayes went from animated to somber in less than a second. “You don’t see this very often, Scarlet. This patient isn’t going to do well.”

I swallowed back my heartbreak for Dana. She either had a severe infection or something else blocking or restricting the veins in her bowel. Her insides were basically dead and withering away. She might have four more days. They would probably attempt to take her to emergency surgery, but would likely just close her back up. “I know.”

“Who’s her doctor?”

“Vance.”

“I’ll call him. Cancel the UGI. She’ll need a CT.”

I nodded and then stood in the hall while Dr. Hayes spoke in a low voice, explaining his findings to Dr. Vance.

“All right. Let’s get to it,” the doctor said, standing from his chair. We both took a moment to separate ourselves from the grim future of the patient. Dr. Hayes followed me down the hall toward the exam room where Dana waited. “The girls doing okay?”

I nodded. “They’re at their dad’s this weekend. They’re going to meet the governor.”

“Oh,” the doctor said, pretending to be impressed. He’d met the governor several times. “My girls are coming home this weekend, too.”

I smiled, glad to hear it. Since Dr. Hayes’s divorce, Miranda and Ashley didn’t come home to visit nearly as much as he would have liked. They were both in college, both in serious relationships, and both mama’s girls. Much to the doctor’s dismay, any free time they had away from boyfriends and studying was usually spent with their mother.

He stopped, took a breath, held the exam-room door open, and then followed me inside. He hadn’t given me time to set up the room before he came back, so I was glad the upper GI was cancelled.

David was shaking the bottles of barium.

“Thanks, David. We won’t be needing those.”

David nodded. Having seen the images before, he already knew why.

I helped Dana to a sitting position, and she stared at both of us, clearly wondering what was going on.

“Dana,” Dr. Hayes began, “you say your problem began early Wednesday morning?”

“Yes,” she said, her voice strained with increasing discomfort.

Dr. Hayes abruptly stopped, and then smiled at Dana, putting his hand on hers. “We’re not going to do the upper GI today. Dr. Vance is going to schedule you a CT instead. We’re going to have you get dressed and go back to the waiting room. They should be calling you before long. Do you have someone with you today?”

“Joey, my boyfriend.”

“Good,” the doctor said, patting her hand.

“Am I going to be okay?” she said, struggling to sit on her bony backside.

Dr. Hayes smiled in the way I imagined him smiling while speaking to his daughters. “We’re going to take good care of you. Don’t worry.”

I helped Dana step to the floor. “Leave your gown on,” I said, quickly grabbing another one and holding it behind her. “Slip this on behind you like a robe.” She slipped her tiny arms through the holes, and then I helped her to the chair beside the cabinet. “Go ahead and put on your shoes. I’ll be right back. Just try to relax.”

“Yep,” Dana said, trying to get comfortable.

I grabbed her requisition off the counter and followed the doctor to the workroom.

As soon as we were out of earshot, Dr. Hayes turned to me. “Try to talk to her some more. See if you can get something else out of her.”

“I can try. All she mentioned out of the ordinary was the bite.”

“You’re sure it wasn’t an animal?”

I shrugged. “She said it was some drunk guy. It looks infected.”

Dr. Hayes looked at Dana’s abnormal gas patterns on the monitor once more. “That’s too bad. She seems like a sweet kid.”

I nodded, somber. David and I traded glances, and then I took a breath, mentally preparing myself to carry such a heavy secret back into that room. Keeping her own death from her felt like a betrayal, even though we’d only just met.

My sneakers made a ripping noise as they pulled away from the floor. “Ready?” I asked with a bright smile.