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Chapter One

The earth trembles. She tastes metal. That’s how it starts on a moonless Sunday in Clearing, Oregon, in the shadow of the dormant volcano locals call Broken Mountain.

Just after 10:00 p.m. Ginny stands at the bathroom sink, a toothbrush in one hand and a paperback in the other. She always reads like this, in minutes parceled out from her packed days—in the bathroom after everyone has gone to bed, or parked in her car when she gets to the hospital a little early. The heat whirs in the vent. She considers staying up to read another chapter. Her husband, Mark, is already asleep in the next room.

Her pager buzzes from the bedroom and she retrieves it from her bedside table. A series of familiar numbers scrolls across the tiny backlit screen. The emergency room. “Damn.”

She dials the number. “ER,” the nurse answers.

“This is Dr. McDonnell. I was paged?”

“Let me get Dr. Pierce.”

Classical music plays energetically in her ear. She sits down on the edge of the bed. Suddenly she’s tired.

One of the cats jumps down from the comforter and stalks out the door toward Noah’s bedroom. But Mark doesn’t stir. He’s learned how to sleep through her nighttime pages. His face is naked without his glasses, his curly hair black against the white sheets.

She turns down the volume on the phone and switches on her lamp. Mark rolls over on his side but doesn’t wake. The music is tinny and faraway in her ear. The floor shakes; there’s a metallic taste in her mouth. Her vision abruptly alters—

Where Mark was sleeping a woman appears. Her face is so familiar . . . ​Edith. Her friend’s hair is always pulled back in a bun at the hospital. Now it fans out in crinkly waves across the pillow. Freckles stipple her shoulders and the tops of her breasts.

Ginny smells warm skin and damp sheets; she hears her own quickened breath. A swell of desire, uncomfortably strong, rises inside her abdomen. The woman reaches out, as if to stroke Ginny’s hair.

Then, in an instant, she’s gone. Mark’s back in the bed.

Ginny rubs her eyes, blinking furiously.

“Doctor McDonnell—” Brian Pierce’s strident voice comes through the phone. “We’ve got a seventy-­five-­year-­old man with a rigid abdomen, white blood count of 24,000, fever of 101.2, peritoneal signs, and free air on abdominal films. Came into the ER about an hour ago. His name is Robert Kells. Can you come in and take a look?”

She’s silent for a beat, her mind still anchored to Edith’s lovely face. “Any major medical issues?” she finally musters.

“A history of liver disease—” There’s the rustle of paperwork. “We’ve admitted him a couple of times for pancreatitis. That’s it.”

“We need to set up for an ex-­lap.” Her brain has come back to life, has switched into the proper gear.

“I’ll tell the charge nurse. Just get on the road. This guy isn’t going to last long.”

Ginny follows her usual routine: pulls on scrubs, scrapes her hair into a short ponytail, and rubs lip balm on her lips. She climbs into her Acura SUV and backs out into the deserted cul-­de-­sac. Her neighbors’ porch lights are off. Behind her house the forest is a dark blank. Rain mists her windshield.

She drives down the hill and across town, and the mountain recedes in her rearview mirror. She usually likes the ride to the hospital at night—the empty streets, the sealed-­in quiet of her car, the gentle tack tack tack of her turn signal as she idles at stoplights. But tonight these things don’t bring her peace.

She’s disturbed by what she saw. She must have fallen asleep for a second. Or she has a brain tumor. She recalls a list of symptoms from her neurosurgery rotation in residency:

headaches

problems with balance

blurred or double vision

seeing things that aren’t there . . . ​

She turns into the staff parking lot. The scrubs, the ponytail, the car ride—they haven’t done their job. There’s an irritating flutter in her chest.

Inside, the fluorescent lights of the ER are a welcome slap in the face. Her clogs squeak against the polished floors. Her patient waits, supine, behind a green curtain in the freezing pre-­op holding room. As soon as she pulls the thin cloth closed behind her she feels better.

“Mr. Kells, I’m Dr. McDonnell, the surgeon who will be taking care of you.” She enunciates each word, speaking over the beeping racket that surrounds them, and looks steadily into the man’s broad, ashen face. He says nothing but holds her gaze firmly.

She picks up his chart. “My apologies. Professor Kells.”

“Robby,” he says in a hoarse whisper. He has thick eyebrows and a full head of gray hair, and she can easily imagine him at the front of a lecture hall.

“I’m going to examine you now. Is that all right?”

He nods.

She rubs her hands together to warm them, lifts his hospital gown, and feels along his pale stomach. “I’m going to press down on your abdomen. Can you tell me if it hurts more or less when I release the pressure?”

She presses, lets go, and watches his face twist into an ugly grimace. He makes no sound. She’s impressed with his stoicism. His silent scowl makes her think of her father, when he first got sick. Professor Kells is about the same age her father would be if he were still alive.

She puts her stethoscope in her ears and listens carefully to the four quadrants of his belly.

“Do you teach at the university?” she asks.

He nods.

“What subject?”

“Philosophy.”

“Impressive.” She picks up his chart again. “Just want to double check. No history of heart disease or arrhythmia? Any cardiac events at all?”

He shakes his head.

“Good. We want to get you back to your books and your students. But to do that I need to find out what’s causing the discomfort in your abdomen. There’s a good chance you have a perforation in your intestine. If you do, and it isn’t repaired soon, you could die. We’re ready to take you to the OR now. Do you give your consent?”

“Yes.”

“We’ll do the very best we can for you.”

He grips her hand with surprising strength. “How about better than your best?” he asks, with a hint of a smile.

“All right.” She laughs. “You got it.”