by Neil Mcmahon
TWICE
DYING
NEIL McMAHON
For Kim
Now the serpent was more than any beast of the field which the Lord God had made.
—Genesis 3:1
Table of Contents
Prologue
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Acknowledgments
About the Author
Praise for Twice Dying
Copyright
About the Publisher
Prologue
Francis Jephson pushed the video cassette into his office VCR and sat while the screen came to life. The film began abruptly. It was silent, grainy, amateurish, with dim, even lighting. The camcorder, stationary, looked down on a room of rough stone, wet in patches from seeping water, curving up to form a high-ceilinged vault. The far walls faded into deeper blackness.
In the foreground, a man lay on the floor. He was unconscious, his face flattened, mouth slightly open, giving him a fishlike look. His face was abraded, as if he had been dragged. A red baseball cap was set on his head.
Jephson knew him. His name was Caymas Schulte.
Caymas began to move, face twitching, eye-lids flickering. He grimaced, one thick hand going to his cheek to touch the raw skin. He rose to an elbow, then heaved himself to his knees, but something yanked him back. His groping fingers found it: a tether around his neck, a horse’s rein of heavy leather. He turned to where it led and stared.
The tether was knotted to a skeletal iron rack, the type used in warehouses. A dozen similar tethers were knotted in a horizontal line beside his, a few feet apart. All hung, severed, trailing lifelessly on the floor. Above each was mounted a white oval: plaster masks of men’s faces, their features contorted with struggle.
Above Caymas Schulte’s place there was no mask, but a white heap of plaster on a board. He reached out to touch it. His finger sank in.
He twisted suddenly in clumsy panic. A figure lunged toward him, a dark blur: slender, agile, covered from neck to foot in tight-fitting black. Its arm slashed downward, severing the rein.
Caymas threw himself backward, flailing and kicking. He rolled away and scrambled to his feet, then backed toward the room’s far walls, lips forming silent words of threat or plea. The figure followed, crouched, gliding. The face was visible now: a chalk-white oval, like a mime’s, with blood-red rings around the eyes. Dark hair streamed down past the shoulders.
The gloved right hand held a knife that ended in a short, hooked blade.
The screen went blank. Several seconds later, a different image appeared.
Jephson watched without moving or changing expression until his desk phone rang. He picked it up.
“Dr. Jephson?” his secretary said. “John Garlick is here for his appointment.”
In a crisp British accent, Jephson said, “Just a moment.”
He switched off the television and waited until the screen died. “All right. Send him in.”
The door to his outer office opened. Two men were standing just outside. The first was white, in his mid-thirties, wearing gray hospital pajamas. His thick dark hair was brushed back in a spiky mane. He was well built and handsome except for a hardness to his eyes.
Behind him stood a much larger, black, security guard, armed with nightstick, handcuffs, and radio.
“Thank you, Harold,” Jephson said to the guard. “Shall we say, forty-five minutes?”
Harold nodded and stepped back, closing the door.
“Sit down, John.”
Garlick walked forward with a hint of swagger, his mouth relaxing into a smirk, and sat.
Jephson leaned forward across the desk, lacing his fingers together, and said, “Let’s talk about your release.”
Chapter 1
The emergency room at San Francisco’s Mercy Hospital was mid-range, with fifteen beds and Level II trauma capability, equipped to handle whatever came through the doors as long as there was not too much of it at once.
Business was usually brisk, and the general degree of tension moderate. Death was not common, although when it did come it tended to happen quickly.
This was a fact that Carroll Monks never lost sight of.
The evening had been crisis-free, and Monks was allowing himself a break, in the faint hope that things would stay that way. His gaze caught the raised hand of Leah Horvitz, the ER’s charge nurse, beckoning him. He walked to the admitting desk.
“A woman just left a phone message for you,” Leah said. “She asked you to go look in your car.”
“In my car? My car is locked, Mrs. Horvitz.”
“I’m just repeating the message.”
“That’s all? She didn’t leave a name?”
“She said you’d know.”
“Did she bit my vehicle?”
“If she did, Doctor, I’m sure she came out second best.”
Monks caught grins on the faces of staff within hearing range.
“I’ll ignore that, Mrs. Horvitz. All right. I’ll be back in a minute.”
It was a damp night, mid-November, with fog rolling in, high thin clouds that might or might not burn off with tomorrow’s sun. Monks walked through the parking lot with vague apprehension, possibilities turning in his mind: a prank, a setup for a mugging, a disgruntled patient who had planted a bomb. His vehicle, a 1974 Ford Bronco made of old-fashioned Detroit iron and the heart of a Percheron, was parked in the physicians’ section. As usual, the nearby Saabs and Lexuses had given it a wide berth. There were no signs of a collision.
But a white gift box, a little bigger than a deck of cards, rested on the driver’s seat.
Monks tried the door. It was locked, the way he had left it.
He turned slowly, his gaze searching the parking lot. There were no other human beings in sight.
He opened the door and cautiously picked up the box. It had a good weight, the feel of something solid. He scanned the parking lot again, then took off the lid.
Inside was an antique straight razor. Its smooth-worn ivory handle was inlaid with a silver caduceus: the winged staff with two entwined snakes, symbol of the medical profession. It was easy to imagine as a prized possession of a doctor from an older generation.
Easier yet to think of the only other person who still had keys to things of his.
Six years ago, a psychologist named Alison Chapley had been called in to consult on a case with a malpractice insurance group which Monks worked for as expert witness/consultant/investigator. She was very attractive, very sharp, and more than ten years younger than he. The richness and promise of her life seemed apparent, and it never occurred to him that she might see him as anything but an amusing curmudgeon.
One Friday afternoon, he had walked out of the company’s offices on Montgomery Street and found Alison waiting, leaning back against the building in a pose he would come to know well, one hand cupping the other elbow, cigarette held between two fingers.
He said, “Could I give you a ride someplace?”
“I think you’re a cripple, Dr. Monks.”
Monks blinked in astonishment, then set his jaw. “Is that a free diagnosis, Dr. Chapley?”
“It’s never free. What do you like?”
“I’m not sure what you mean.”
“You know what I mean.” She pushed away from the wall and handed him a business card with an address hand-written on back. �
�Drop by. Tomorrow would be fine.”
Her house was near Bolinas, secluded from its neighbors, on a low bluff overlooking the Pacific. Her car was there, but she did not answer the door. Monks hesitated, but then stepped inside and walked through, calling her name. A pair of French doors opened onto a deck. He saw that she was sunbathing in a lounge chair, her back to him.
He did not realize she was nude until he said hello, and she leaped to her feet, gasping, hands flying to cover herself.
Monks said, “You shouldn’t leave your door unlocked. Anybody could come walking in.”
Beneath the sheen of oil she was flushed—vibrant, he would realize later, from the drug XTC.
“I like surprises,” she said, and let her hands fall to her sides.
Alison had surprised him many times after that: sometimes by leaving a gift in his vehicle. He began to glean that each one had a significance that only she understood. A photograph. A book. A spike-heeled shoe.
A black silk scarf, embroidered with gold.
The parking lot’s argon lights, blurred and diffused by fog, colored the night a garish pink-orange, bringing to mind his ticket home from eight months of war: falciparum malaria, tiny mosquito-borne protozoa that invaded the liver and burst forth to storm the bloodstream, killing a million human beings per year and forcing fevered delirium on hundreds of millions more.
He remembered his last vision of Alison, burned into his mind through a fierce haze of vodka on a night he could almost believe was one of those hallucinations: his hands tightening that scarf around her throat, urging her slowly and not ungently to the floor beneath him, with her choked sounds that might have been fear, or pleasure, or laughter. That had been five years ago. He had not seen her or spoken to her since.
Monks gazed into the night with the dense weight of the razor clasped in his palm, rubbing the smooth ivory between thumb and forefinger, as if it were a talisman that could help him see into the reason behind this new offering.
He was still standing there when a hospital attendant came running out of the ER.
“City Triage Base is on the phone, Doctor. You better hurry.”
Monks tossed the razor into the Bronco’s glove compartment, and ran.
Leah Horvitz was working the phone at the Mobile Intensive Care station, the hospital’s contact with paramedics in the field. The tension in her face brought him a jolt of adrenaline. He automatically noted the time, 8:47 P.M., and waited beside her, gathering information from the questions she asked into the phone. Within a minute, he had most of the story.
The Saturday Night Knife and Gun Club had just held a meeting in the Mission District. The result had been a gangfight, or, in official parlance, a “multiple casualty incident.” The main Level I Trauma Center at SF General was even more of a zoo than usual. The spillover was being farmed out by the city’s triage base to other area hospitals, whether they wanted it or not.
“We’re getting two,” Leah said, hanging up the phone. “One critical, gunshots to chest and abdomen. The other not critical, shot in the thigh. They think it was automatic weapons. ETA nine minutes.”
Monks glanced at the faces of the people in the waiting room. They were going to have to keep waiting.
He turned to scan the ER, envisioning the movements of personnel and gurneys as they would come in, constructing a mental flow chart of probabilities. It was a good guess that the slugs were nine millimeter, which seemed to be the round of choice among the rapid-fire crowd these days. It was also likely that they were lead, which tended to deform and stop within the body. Jacketed rounds were more likely to exit, in which case the chest wound would be on his way to a different institution.
High-powered lead slugs in chest and belly. This was going to be quick and nasty.
His gaze settled on his resident, a lanky straw-haired North Dakota farmboy with the singular name of Vernon Dickhaut, who was sitting across the room on a gurney, one leg swinging, absorbed in a chart.
Monks said, “I want Dr. Dickhaut to take this. Report to him, please.” He followed Leah’s scurrying walk to Vernon, who glanced up with his trademark expression of bewilderment: a look suggesting that he had just been bashed with a two-by-four.
Monks said to him, “You’re in charge until one of us says different. Leah?”
She went into a rapid rundown of the incoming situation. Vernon set down the clipboard, his startled blue eyes widening further.
“The critical’s got trouble breathing and low blood pressure,” she said. “Gained twelve points with MAST suit inflation.” She stopped talking. Vernon’s gaze moved to Monks. Monks stared back impassively, arms folded.
Vernon was on rotation, had been in the ER just two months, and had some experience handling trauma, but never anything like this. Monks could see the realization starting in his face that he was going to be literally holding a life in his hands with minutes or even seconds to save it, that a slip or hesitation could make the difference.
Monks said, “You don’t have to do this.”
Vernon’s shoulders shifted toward the wide glass double doors, where in approximately seven minutes an ambulance would arrive to unload its bloody cargo.
“I’ll do it.”
“Good. Think out loud.”
“I see two immediate problems.” Vernon spoke hesitantly, with the care of a schoolboy at the state spelling bee. “The critical’s losing blood fast. Maybe a clipped artery.”
“In his chest? Belly?”
“I’m guessing belly. If he had a chest cavity full of blood, there’d be other signs.”
“Second problem?”
“His breathing. Sounds like a lung’s been hit.”
Monks allowed him a nod. The MAST suit, Military Anti-Shock Trousers, compressed bleeding vessels and maximized circulation. The suit’s inflation had increased blood pressure, which probably meant a damaged artery; if it was in the chest, there would have been other signs, from hacking up great bloody gouts to immediate death.
“What about the other guy, the thigh wound?”
“He’s not critical. We make him comfortable and get to him later.”
“Go on.”
“You did a lot of this, didn’t you?” Vernon said. “Gunfire.” He pulled nervously on his large fingers.
Monks understood the unspoken plea for help and relented another notch. Guessing at the damage was one thing. Knowing where to start was another.
“I’d assume the blood loss is stabilized and worry instead about his breathing,” Monks said. “Ever done a chest rube?”
“Once, in dog lab.”
“Same procedure, Vernon,” Monks said kindly. “The stakes are higher. Mrs. Horvitz is waiting for orders. I’ll meet you in the trauma room in three minutes.”
Monks stayed long enough to hear Vernon’s hurried instructions to Leah—bring in lab and X-ray, alert the OR, full cart in the trauma room with all personnel standing by. Then Monks walked through the ER, the kind of one-minute scan that told him without conscious thought most of what was going on: which cubicles were open and closed, patients’ appearances, positions of the nurses, whether clipboards on the desk had blank charts or lab results and EKGs. His ears picked up a bedside pump measuring medication into an IV, a child’s cry, the hiss of an automatic blood pressure cuff. The room was stirring in an imperceptibly different way now. Staff were moving with the kind of hushed speed used around patients who were already scared and about to be a lot more so.
Monks stepped into the trauma room. The cart was already there, brought by a nurse who was young and relatively new to the unit: Jackie, he recalled. It took him a moment to supply the last name: Lukas. She was lean-faced, with sandy-hair pulled back in a ponytail; not pretty, but attractive in an athletic sort of way. She smiled nervously and murmured a greeting. He had worked directly with her only a few times, and not in crisis. There was no telling how she would hold up. With Vernon, that made two unknowns. Monks decided to make sure Leah Horvitz was nearby wh
en the action started.
He glanced over the can’s equipment and adjusted the overhead light as he spoke.
“Lay out a suture set and a couple of chest rubes, thirty-three French. Gowns, goggles, two pair of gloves apiece. Seven and a half for me. Dr. Dickhaut’s are probably bigger.” He noted that she moved quickly and without questions, a good sign.
Vernon entered, and all three stepped into plastic barrier gowns, mandatory trauma apparel in the age of AIDS. Monks caught Vernon’s eye and held up a second pair of gloves. The trick was one a nervous resident might or might not remember. The outer pair could be stripped off after the exterior body examination, leaving the inner gloves sterile for going in without pausing to reglove. It could save as much as twenty seconds. He stepped to the door and looked at the clock. It was 8:58. The ambulance was a minute late.
Then he caught the rumble of an approaching vehicle and backup beeper, quickly growing louder. As many times as he had heard it, it still brought a rush. There was no other sound quite like it.
Flashing lights moved in to sweep the room, pulsing reds and blues from the ambulance and squad cars. Personnel crowded through the door. Alarmed patients edged away, staring. Monks walked back to Vernon, who was standing still and pale, and gripped his upper arm hard.
“‘Gird up now thy loins like a man,’ “Monks said, “‘for I will demand of thee.’”
The critical came in fast on a gurney wheeled by paramedics, looking like a captured creature out of a science fiction movie: strapped with nylon webbing to a backboard, head taped down and neck pinned by a cervical collar, shirt ripped off his blood-soaked torso, the bright orange MAST pants ballooning around his body. Bags of saline fluid hooked to the gurneys rack dripped through IVs into each arm. He was moving feebly, blood bubbling between his lips. Vernon strode beside him, leaning over, fingers examining head and mouth.
“I’m a doctor, you understand me? You’re in a hospital, you’ve been shot.”
