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CHAPTER ONE

“LAURA—you fool!”

Laura Burnside almost dropped the arms of the woman she was dragging along the ground.

Freezing, eyes darting around the chaos, heart shaking her apart, she sought the source of the furious shout.

Someone’s shoulder slammed into hers, jolting her back.

Concentrate, Burnside, all her senses screamed. It doesn’t matter who’s calling you or calling you what. It can’t be him anyway. Get out of here. Drag that woman away…

Another outburst of shots. Another man fell a few feet away from her. No way to help him, not now. One victim at a time. Bending again, tightening her grip on the woman’s wrists, she dug her heels in and pulled. Much heavier than her, getting heavier with every inch. Pain stabbed her side again.

Fool. That was what the voice had called her. His voice. It couldn’t be him, of course. What would he be doing here, in Buenos Aires, hundreds of miles away from his home and work? His rage must be reaching out to her all the way from Santa Fe. No one disobeyed Armando Salazar.

It could also be her mind calling her a fool, using his voice. And it would be right. She’d gotten herself into this, thought she could do it. It was amazing what looked plausible—not to mention how a mind could stray—in a desperate situation…

Violent purple with sickening yellow blotches exploded behind her eyes. Someone’s forehead had rammed her left cheekbone. She staggered, letting go of the woman’s wrists, colors fading to gray. She held herself still as her consciousness wavered, drained, willing light and colors to come back. If she succumbed, let herself be KO’d, it’d be over for that woman. For her.

Another body, then another collided into her, fists and feet plowing into her gut and shins. She was the only one going against the tide, and they were sweeping her backwards with them in their blind escape path.

In the uproar, her own angry shouts reached her ears as if from a distance. The woman. She had to get back to her. She didn’t know how, but she made it.

Just as she bent to her again, a thundering “Laura!” drowned even the cacophony of human shrieks and gunfire.

It was him.

Her head swung instinctively, violently, looking for him in the stampede. The next second a missile whizzed by her head. A fist-sized rock thrown with all the strength and fury of someone deranged by oppression and desperation. If not for his shout, it would have smashed her skull.

Then he was there, materializing above her, face grim, wings spread, filling her vision.

This is how Dracula—no, Batman—must look. A little voice inside her made the ridiculous, untimely observation. Swooping down on his quarry, staggering, scary even to those he saved.

In the next heartbeat he snatched her up and under the protection of his massive body. It was almost a surprise to realize his spread wings were not a cape but a jacket, held up to block rocks that were falling short of their targets, pelting them instead.

“Don’t— No…” She resisted him, desperate to return to her casualty. He only swept her higher. Her feet kicked air.

Her fingers dug into his arm, his chest, anywhere, trying to gain his attention, to regain her freedom. “Put me down, Salazar! That woman—she’d been trodden on—and those two men…”

She was talking to his jaw as he plastered her to his side, running with her to… Where was he going?

The idiot man had taken them right into the thick of the riot!

Her breathing stopped as the masses battered them. She’d rushed to the woman when they’d started receding, forced back by the police forces, when she’d thought she’d had a chance of pulling her away. It had been scary enough, dangerous enough then. She had the bruises to prove it. But now—being right in the middle of it all…

Dread smeared her vision gray and red. Huge and strong though he was, no way was he a match for this mindless crowd. He was starting to stumble, her weight no doubt hampering him, compromising his balance.

“Put me down, Salazar!” This was no longer indignation. This was survival. If he didn’t, he’d soon be brought to his knees. Then they’d both be trampled to death.

“Shut up, Laura!” He swung her around to face him, forcing her thighs around his waist, one large hand clutching her buttocks, the other a steel harness behind her back, carrying her like she’d once carried her baby brother and sister. “Hold on—tight!”

She did, clamping her legs around him, clinging for dear life. Not that she needed to. He crushed her if he were trying to hide her inside him. Her flesh felt battered into his, her breath took in his heat and sweat and anger.

Her senses sharpened, receded. Fear and anger and awareness dragged her under. She made herself surface, frantic to see what was happening around her, where he was taking her. One eye’s field of vision was all she managed to free. The hundred and four jarring steps she’d counted had delivered them from danger and to one of La Clínica’s beat-up ambulance vans.

One violent yank brought one of its double doors crashing back on its hinges. Expecting to be thrown inside with the same vehemence, she braced herself. The next second she couldn’t hold back her surprise at his extreme gentleness as he deposited her on the paramedic bench. Her eyes darted to his face. Nothing could have been harsher.

So what else was new? Ignore him.

Impossible to do that, as usual. Especially now, with his bulk blocking her view. Then he moved, followed her inside, and she could finally see the woman they’d left behind. She and the other victims were still motionless in the middle of the street. The mob had veered into a side street, some persistent elements still going back to pelt the police forces, provoking more warning shots.

She’d made a lousy call before, going out there before the riot had receded enough. Now there were only the police in the background. If they made a run back for the victims, shouted that they were doctors, they could reach them, carry them back. She measured the distance, gulped down a steadying breath then moved. Armando moved first, shoving her down again. No gentleness this time.

“Por Dios, get down and stay down! I didn’t risk getting my head smashed in to get you off the street just so you’d dash out again and succeed in getting yourself killed.”

She would have ignored him now if she wasn’t losing the wrestling match with him. Better luck wrestling with steel handcuffs! Impotence and fury crackled on her lips. “What kind of doctor are you to just leave victims behind, Salazar?”

“I’m not leaving anyone behind, but you’re staying put!” He hauled a hard collar and a rebreather mask with an oxygen reservoir from the shelves lining the ambulance walls, sprang from the van, slammed the door behind him and locked it with the remote control.

For a few moments rage threatened to burst her skull. How dared he? What made it OK for him to run back out there and not her? And he couldn’t possibly carry them all! What was he trying to prove? That he really was a superhero? What was his special power, Latin chauvinism? Just because he’d managed to swindle her out of her position as aid operation leader…

Blasts erupted again amidst a new uproar, startling her out of her fury. This time nature joined in, then drowned the human frenzy as a sudden, violent downpour started pounding the van. From the rear window she saw another horde, this time bigger, tens of thousands turning the corner of the main street and heading for the police forces. And in between there was Armando, carrying the woman and leaning over one victim, then the other.

Seconds stood between him and being squashed in the middle of the mob. And he was wasting them!

Buy him time. The thought screamed in her mind.

She flopped back on the stretcher, prayed that he’d armed the van’s alarm system by locking it and rammed both feet into the rear window.

She didn’t even hear her own shouted ‘Yes’.

The siren blared, jarring enough to cause the antagonistic sides’ momentary hesitation. A hesitation Armando used to rouse one of the fallen men by pressure on his forehead, to shove him out of harm’s way and, with the woman held high in his arms, to squeeze between the two waves of hostility before they collided.

Laura returned her attention to the door. How the hell did that doorhandle work? She’d definitely unlocked it but the handle just wouldn’t budge. Frustration roared in her ears, seethed from her lips. “Dammit—damn you, Salazar!”

She had to get out, meet him halfway, help him. Yes—the oxygen tank!

The window withstood the first swing, fragmenting but holding up. A cry of rage and a second swing made a big enough hole for her arm. In a second she’d worked the handle from outside, got out and was already running to him—only to watch him lurch over the woman in his arms.

His name was torn from her. “Armando!”

He’d been shot. He’d die.

God, please, no, not again!

Her feet pounded the hot, wet tarmac, every step shattering a pool of rain and transmitting a bolt of agony to her right side, a reminder of how close she’d come to dying herself. She didn’t care. She had to reach him, save him…

He fell to his knees, chest heaving, still clutching the woman. Laura’s heart stuttered and stopped for the moments it took him to struggle back to his feet, hauling the woman in a more secure grip, staggering onwards. Her heart was hammering again, almost bursting with a brutal mix of confusion, dread and hope. There was no blood on him—but if he’d been shot in the back, she wouldn’t see it. Were they shooting real bullets now?

Had he or hadn’t he been shot?

A hundred feet away, his hoarse warning hit her, explaining everything. “Tear gas…” Then he succumbed to a fit of uncontrollable coughing.

So that was it. In his exertion he must have gulped deep of the irritant chemical. Like breathing in fire…

The next second, her instincts kicked in. She couldn’t risk exposure too. She ran back to the van, as far away as possible from the incapacitating fumes that she could now see rising, even among the sheets of rain pounding down on the combatants. But in their desperation to escape, the mob was getting even more dangerous, spreading towards Armando in nightmarish tentacles.

But he was ahead, fast and strong and heading to…

Oh, God, where was he going?

He was no longer heading in her direction. He’d end up in the middle of the riot again, the way he was blindly… But of course! He was blind. His eyes must be burning, profusely tearing, lids squeezed shut with blepharospasm—beyond his ability to open them again.

Her mind raced. Rushing out to lead him back was out of the question. One way, then—she had to be his eyes. If he could hear her frantic shouts over this nightmare…

“Armando—turn right! Right!” He stopped. He’d heard her, thank God. “Make a ninety-degree turn. A bit more. Yes, yes—that’s it. Keep going in a straight line now. Faster. There’s a sidewalk in about twenty paces. I’ll shout to you to stop before you reach it.” She had to stop then, to catch her breath, grind her teeth. Every shouted word was lancing a hot arrow into her chest and abdomen.

“Stop!” He did, still heaving with racking coughs. She forced more directions out. “Just one more step and you’ll hit the edge of the sidewalk—yes, you’re there. It’s high, more than a foot. Yes, yes—now four of your paces and you’ll come off it. No—watch it!” He stumbled off the sidewalk and fright forced the air out of her. He straightened, his body language hesitant and anxious as she gasped for oxygen, fighting against the mounting pain. She failed in both but still shouted, “It’s all clear to where I’m standing. Just follow my voice.”

In twenty seconds he’d stumbled to her and she took some of the woman’s weight off him, directing him until they had her on the stretcher. She harnessed her in, then turned to him.

His face was drenched in tears, his nostrils flaring convulsively, his eyes spasmed shut as tears gushed down his cheeks and off his hard jaw. Every inhalation shrieked in, and came out in frightening barks of abrasive coughing. She pushed him through the doorway leading to the driver’s compartment and shoved him down in the passenger seat.

Rushing back to the patient compartment, she snatched a look at the mayhem outside. The man Armando had roused had stumbled out of danger. The other casualty, whom he’d managed to drag aside, hadn’t. She had to rush to him.

She kneeled by their casualty, prying off the rebreather mask Armando had placed on her face. It would protect her against the tear gas.

Armando’s labored words carried to her, and a jolt of horror paralyzed her in mid-motion. “He’s…dead. Rubber bullet…through the…eye.”

She knew so-called ‘safe’ rubber bullets could cause considerable damage, according to the distance they were fired from and the area of the body they hit. She hadn’t known they could kill.

Now she knew.

Urgency bubbled over inside her. Help those you can.

She reached for Armando, shook him. “Keys, Salazar.”

He only pointed to his right back pocket, almost coughing his lungs out again. Moving his convulsing, massive body was almost impossible. She was pummeling him in frustration by the time she had him supine over both driver and passenger seats. Now to fish the keys out. Her fingers felt like wet spaghetti and his jeans—were they painted on or what?

Get those keys. No time to think where you’re shoving your hands.

At last she succeeded. Too late. The mob’s sentinels had reached them. One pulled the driver’s door open, jumped in, shouting in Spanish at her. A blind need to protect surged inside her, blanking out the pain. She leapt over Armando, rammed the man back, snatched the door from him, slammed it shut and central-locked the van.

Time slowed. Her mind raced. Everything was suddenly in pinpoint focus, one thing filling her awareness.

Get Armando and the woman out of here.

In a vacuum of calm, she shoved Armando back in his seat, jumped into the driver’s seat, fired the engine and put the van in motion, showing the mob who were now battering it with their fists and ramming it with their bodies that she wasn’t about to let them stop her or enter it, yet still managing to give them enough time to move out of her way.

It was street after street of that. Suspended in reaction, she drove on and on until her path cleared. Then she floored the pedal. Armando’s choking curses rose as his unrestrained body bounced off hers then slammed against the door with every violent pitch. Strange—her mind didn’t register that she was driving roughly. Then his harsh wheeze filtered to her above the screaming engine noise. “Stop. Far enough…”

How he knew that with his eyes closed, she didn’t know. She had no idea where they were. All around were the rolling plains of the magnificent pampas, only a few cars on the horizon of the near-deserted road.

She slowed down, pulled up off the road, eyes flying to the clock.

Unbelievable.

Only thirty-five minutes. From the moment her cab had refused to go any further when the riot alert had broken out, leaving her to reach her destination on foot, and she had gotten mixed up in all that.

She turned to Armando. His coughing was abating, but his lips were blue with oxygen deprivation and his eyes were still spasmed, tears still pouring.

“Water…in…the back…”

She understood. To counteract the effects of tear-gas after removal from exposure, eyes, nose and mouth had to be copiously irrigated with water or saline. In seconds she returned with four bottles. He made an urgent gesture demanding she hand them over.

“Shouldn’t you be breathing easier by now? Maybe a bronchodilator…”

He twisted a bottle open, choked, “See to…our casualty…”

He was right. Simple triage made their casualty the priority. She left him rinsing his eyes and went to the unconscious woman.

Laura snatched a look at the woman as she turned on the suction/aspiration and wall-mounted oxygen outlets, snapped on gloves and chanted under her breath, “A, B, C, D, E.”

As a surgeon, she usually didn’t get to handle the ABCDs of emergency resuscitation, but they’d been so deeply ingrained in her during her early training, they were second nature. Mentally ticking off the procedures, she simultaneously and seamlessly implemented them.

Thrust jaw above hard collar to overcome upper airway obstruction. Suction excess secretions in trachea. Gather equipment for intubation. Ventilate with one hundred per cent oxygen. Assemble laryngoscope, lubricate cuffed endotracheal tube, cut tape, ready clamp, syringe, flexible introducer and forceps. No need for induction anesthesia since the patient was already unconscious. No gag reflex. No need for local either.

In seconds she had the woman intubated, the tube connected to the bag-valve combination and was ventilating with oxygen. She looked at the chest. No improvement in air entry. She reassessed her measures, made sure the ET tube was in place in the trachea. It was. Airway secure but breathing not any better; shallow, strident 55 prm.

Exposing her patient’s chest, she saw the tell-tale paradoxical movement of her ribs, a segment moving in while the rest moved out with breathing. Flail chest—ribs broken in a row and moving independently of the rest of the chest wall.

Stethoscope already drawn, she gave the chest a listen. Normal breath sounds on the right side, none on the left. On percussion, stony dullness at the base of the lung. Hemothorax. But the trachea was deviated. Probably hemopneumothorax—both blood and air gathering around the left lung, collapsing it and interfering with the right lung and heart function. Fatal if the building air and blood weren’t evacuated—fast.

She picked an angiocath to perform a needle thoracostomy, slipping it between the ribs and into the pleural space. She heard the distinctive rush of air in relief, then placed a one-way valve on the end of the angiocath to prevent air re-entry. Immediately, there was an improvement in air entry, if not in breath rate.

Check circulation. Pulse 180—ectopics all over the place. Blood pressure 80 over 50—hemothorax must be massive. Going into shock.

She exposed the woman’s arms, snapped tourniquets on both and inserted two wide-bore 14-gauge IV cannulae. The woman moaned in protest around her tube.

“Sorry I had to prick both arms!” She released the tourniquets, hung two Ringer lactate solution bags from the IV holder, connected their tubing to the lines in the arms, set the drip to maximum, then swooped for tube thoracostomy instruments to drain off the blood. First, local anesthesia.

“This sting you’ll thank me for,” she said soothingly as she injected the local anesthetic and disinfected the area until it took effect.

“I doubt she…understands a word of English—if she can hear you at all…”

Laura started. Armando—she’d forgotten he was here.

“She’ll understand my tone, that I’m taking care of her!” She snapped her eyes back to the instrument compartment and extracted a 38-French large-bore chest tube, explaining why she needed it. She looked him over as he came to crouch beside her. “So you’re better now?”

“Better than you. Move—I’m doing this.”

She protested but he’d already snapped on gloves and was taking the scalpel and tube out of her hands. He wasn’t breathing much easier, but she was sweating. Not the stuffy sweat expected with the heatwave that was ending March, Argentina’s last summer month, but the cold, sick sweat of depletion. Bright pain had settled in her right side. Gray mist had crept up over the rest of her a couple of times back there. He was probably in better condition than her. She made way for him.

Flopping into the attendant’s seat, she watched him recline the cot so that their restrained patient lay in a 50-degree reverse Trendlenburg position with her legs down. Both that and the incision between the ribs in the mid-axillary sixth intercostal space made for best drainage of blood. In deft, sure moves, he punctured the intercostal muscles and pleura with a curved hemostat clamp, advanced and secured the track with his finger and inserted the tube into the pleural cavity. Blood gushed out, just as she’d predicted. He secured the tube with a suture and tape and connected it to an underwater-seal bottle, attaching it to the suctioning device.

She busied herself with a secondary assessment of the woman’s vital signs. Breathing down to 24 and blood pressure up to 110 over 70. Measures working. She told him. He nodded. “Let’s look her over,” he said.

Apart from a multitude of bruises, a quick exam for dysfunction and a full exposure didn’t reveal further significant injuries. Eyeing the bottle for the collected blood, Armando frowned. It was over 900 ccs.

“A lot,” she said.

He gave a slight shrug. “But it has almost stopped coming. She’ll be OK. Load me 10 mg diazepam while I decompress her stomach.”

“But her GCS is 5—6 at best!” Centrally depressant drugs were contra-indicated when consciousness was compromised and scoring on the Glasgow coma scale measuring responsiveness and alertness was below 8. “How can you consider sedating her?”

“I believe she lost consciousness with respiratory distress and shock, not from a head injury. If you hadn’t noticed, she’s lightened up.”

“What if she has? Why not just let her wake up, extubate her and put her on positive pressure ventilation with a face mask?”

“She’s a cervical spine injury suspect. If we need to operate further, and it turns out she does have a cervical injury, this ET is our one safe chance of having one in. I want it left in.”

Laura mulled this over, watching his every move as he slipped in the nasogastric tube and emptied the woman’s stomach. Incisive, ultra-efficient.

And right.

Damn him.

In seconds, she’d slipped the diazepam into the woman’s drip, hooked her to the cardiac monitor and raised her head. She found him watching her in turn, something like surprise in his bloodshot eyes.

He shook his head, made a strange, wheezy sound—an incredulous laugh? “Good work!”

He was surprised, double damn him! How dared he be surprised?

But really, why should she be surprised? She should be used to his opinion of her medical competence, of her worth in general, by now.

Still biting her tongue, she watched as he checked their patient one last time, then rummaged for a syringe, loaded it with an ampule diluted with saline and injected himself subcutaneously.

“Ventolin,” he rasped, then muttered something else under his strident breath.

So he did need a bronchodilator and… What had he said?

It sounded too much like Laura Loca to her. Crazy Laura.

“What did you say?”

“So you heard me, huh?” His shrug was careless as he crossed to the driver’s compartment, throwing a calm “Good” over his shoulder.

In seconds he was revving the engine loudly and putting the van in gear, forcing her to scramble to the passenger seat.

“I’m crazy? I’m not the one driving a car fifteen minutes after being zapped with tear gas.”

“One of us has to and apart from my eyes stinging like hell and my skin and lungs feeling about to combust, I’m in a far better condition than you—Laura Loca!”

“You’re saying it again!”

“Don’t mention it. What the hell do you expect? What did you think you were doing, running out like that? Was reporting me such a desperate priority that you didn’t mind risking your life to do it?”

“Reporting…? Listen here, Salazar—”

“No, you listen here, Laura Loca. You didn’t have to sneak behind my back. You wanted a report delivered to GAO’s central liaison office, I would have delivered it for you myself, even if you’d painted me black in it, even if you’d lost me GAO’s backing. And no matter what else you think of me, I’m your surgeon and I, and only I, say when you can leave your hospital bed. When I do, it won’t be so you can go on another death-defying escapade. This one almost got me killed. Your last one did manage to kill Diego!”