SAMPLE CHAPTERS

CHAPTER 1

LOOK INTO MY EYES

Trauma-Surgical Intensive Care Unit, Harbor-UCLA Medical Center

3:43am

As she prepped the patient, Alicia Saldana realized that people were terrible at stabbing each other to death.

She’d worked on dozens of stab victims on the long journey to her trauma surgery fellowship. Many, like the sedated gang member on the operating table, were stabbed only once. Of course, a punctured lung from one wound in the chest was an unpleasant and risky experience. But when some people survived thirty or more, one thrust seemed like a half-hearted effort.

With an expensive surgery, the thug would live to deal more drugs, knock over more liquor stores, and do a terrible job of trying to kill other thugs.

Some people should do the world a favor and just die.

Alicia pushed aside her uncharitable thoughts. A few bad decisions as a teenager and she could be the one lying on the table instead of the surgeon standing beside it.

This thought made her pause and look around the surgical suite. The eight medical specialists each represented 18 to 30 years of education. Surgical and anesthesia machines worth millions crowded the room. They hummed, beeped, and breathed, their wires and tubes sprawled about like the tentacles of some high-tech monster.

The room represented the best of science and education, all with the goal of servicing the human body—that most capable yet fragile organism.

Never forget how blessed you are to be here.

But it was too early for such lofty thoughts to keep her from yawning long and loud into her mask.

“You aren’t nocturnal yet?” Charles Wong, a surgery resident, asked.

“I should be by now. Why can’t people stab each other during the day?”

Charles shrugged. “That’s when I stab people.”

Roger Duncan, the anesthesiologist, looked up from his iPad. “I like to stab people in the morning. Starts the day off right.”

Before the conversation completely derailed, the suite’s double doors opened and Gerald Alvey, Director of theTrauma Division, stepped inside.

Dr. Alvey’s presence seemed to electrify the air in the operating room. The nurses stopped chatting and focused on pre-op paperwork. Dr. Duncan set down his iPad and monitored the anesthesia equipment. Charles double-checked the surgical tools with the circulating nurse.

Alicia reacted to Dr. Alvey’s appearance like the rest of the surgical team. She stood straighter. A rush of adrenaline swept away the fog of exhaustion.

She’d applied for one of the two Surgical Critical Care fellowships at UCLA that opened each year in hopes of working with Dr. Alvey and the other accomplished attendings. She was proud to be one of the few Hispanic women in history to have been accepted.

Dr. Alvey walked to the center of the operating room and made sure everyone was paying attention. “You guys got it all wrong.”

The adrenaline in Alicia’s veins boiled. Charles and I triple checked everything and —

Dr. Alvey said nothing for several seconds. “You should stab people when you get home from work. Very therapeutic.”

An involuntary laugh burst from Alicia’s lips as her panic evaporated. The rest of the team also chuckled, no doubt as relieved as Alicia.

Despite opening with humor, Dr. Alvey wouldn’t allow a patient to go unattended for long. He called for the surgical pause. “Everyone on me. You know the drill.”

One by one, the surgical team stated their names and roles. Dr. Duncan confirmed the patient’s name and Dr. Alvey stated that the team would be repairing a traumatic pneumothorax.

Finished with the time out, Dr. Alvey stepped up to the operating table and looked at Alicia. “Have you repaired one of these before?”

Tension twisted Alicia’s stomach. “Yes. Many.”

“Did your patients survive?”

“Of course.”

“I want you to take lead.”

It was the first time Dr. Alvey had asked her to lead a major operation. Tension surged through her, but she was thoroughly prepared. “Thank you, Dr. Alvey.”

“Good. I’ve worked 23 days straight and I’m exhausted.”

Alicia agreed with Dr. Alvey’s self-assessment. Dark circles framed his red, inflamed eyes. He screwed them shut every few seconds as if they itched. His previously tan skin was pallid, bordering on anemic.

“Take it away,” Dr. Alvey said. “Let’s see what you can do. Charles, you assist. I’ll just observe for now.”

Charles stepped around to Alicia’s side of the table.

Alicia looked down at the patient. He lay on his side, most of his body covered by blue surgical drapes. Amateur tattoos decorated the exposed parts of his back and clashed with the blue anatomical landmarks that Charles had drawn with a marker. Betadine stained his skin orange and a chest tube drained air and blood.

Here we go. “Scalpel.”

A nurse handed it to her. Alicia inserted its blade just below the patient’s nipple and cut a ten-inch, semi-circular incision that ended near the shoulder blade. Blood oozed out and slithered along the skin. A few more slices deepened the cut through layers of tissue and fat. She switched to a Bovie pen and burned through the intercostal muscles. The buzz of high-voltage electricity and the aroma of cauterizing flesh filled the OR. It smelled like barbecue.

Charles was ready with a Finochietto to spread the ribs. He placed it and ratcheted it open. The bones gave way with a series of wet, muffled pops and the cartilage groaned as it stretched. Blood dribbled down the patient’s back and added its scent to the already pungent mix of betadine, burned muscle, and the new-car smell of the surgical drapes.

Alicia glanced up at Dr. Alvey. Despite his exhaustion, she could tell his red-rimmed eyes assessed every move she made. She wondered if part of Dr. Alvey’s exhaustion stemmed from his extreme weight loss. When she’d interviewed with him several months ago, he looked like a different person. He’d been at least fifty pounds heavier. When she’d arrived for her fellowship, she almost hadn’t recognized him.

At first, she was concerned for his health. But the rumor around the unit was that Dr. Alvey was a client of StriveNow—some kind of exclusive and secretive health program popular with celebrities and the wealthy. He refused to answer questions about StriveNow and claimed to have signed a strict non-disclosure agreement that forbade him from sharing any details.

So far, the program seemed to have helped him. Even in the two weeks since starting her residency, Alicia noticed that he’d lost more weight, and four days ago he’d announced to the surgical team that his type 2 diabetes had resolved.

Tonight was the first time she’d seen him when he wasn’t full of energy.

Charles stepped aside to allow Alicia access to the opening. She cut through the pleura lining into the chest cavity. Blood spurted onto Alicia’s gown. She kept cutting and blood gushed onto the operating table. It ran down her legs and pooled in her tennis shoes.

“Suction,” Alicia said.

Charles yawned, then suctioned the blood, quickly revealing the lung, which quivered with every beat of the neighboring heart.

“Let me assess the wound.” Dr. Alvey rounded the table, squinted hard as if trying to force the exhaustion from his eyes. He slid his gloved hand into the patient’s chest cavity and circled the lung.

Then he screamed.

Startled by the loud, inhuman screech, Alicia jerked backward and nearly fell. It took a moment to process what happened.

Yes, Dr. Alvey had screamed. Now he rubbed at his eyes in frantic, erratic thrusts, smearing the patient’s blood over his face.

Alicia snapped into action. She grabbed his arms and tried to keep him from rubbing more blood into his eyes. “Stop that! What’s wrong?”

Dr. Duncan jumped to his feet, a dumbfounded expression on his face.

“Alert the Emergency Department,” Alicia yelled at the nurses. One of them ran to a phone on the wall and dialed.

“We need to get him out of here,” Charles said.

As suddenly as he began screaming, Dr. Alvey went quiet. He stopped fighting Alicia for control of his arms.

“Wait, wait.” Dr. Alvey was doubled over, his eyes clamped shut. His fingers gripped the side of the operating table. He hissed breaths between clenched teeth. “It’s getting better.”

The surgical team froze, all eyes watching Dr. Alvey as his breathing normalized.

“What’s happening?” Alicia asked. “Talk to me.”

“I started to lose vision and had severe pain in my eyes. I think it’s going away.” A few moments later, Dr. Alvey stood up to his full height and turned toward Alicia, his eyes still held shut. “Alicia, look at my eyes.”

Alicia moved closer. “Open them.”

With some effort, Dr. Alvey managed to pry them open.

Alicia struggled to comprehend what she saw. The green and white areas were replaced by an inky, shimmering blackness. It was as if the pupils had swelled to consume everything else. Oddly reflective, the blackness caught the glare of the surgical lights.

The blood that Dr. Alvey had smeared around his eyes contrasted with the dark pools. He looked devilish.

“Dios mío.” Alicia involuntarily crossed herself, a childhood of superstition overriding a decade of science education.

“What?” Dr. Alvey asked.

But a second later, he collapsed.

He fell forward, made no effort to catch himself, and his face slammed into the patient’s incision. He bounced off the surgical table and flopped to the floor, landing on his back.

“Call a code blue STAT!” Alicia fell to her knees beside Dr. Alvey and checked his neck for a pulse.

Nothing.

She looked at Gerald’s blacked-out eyes and found no life there. It was as if he’d passed from vibrant life to death in an instant, something even the most severe heart attack or aneurysm couldn’t accomplish.

“Out of the way.” Dr. Duncan knelt and also checked the neck for a carotid pulse, then held his ear over Dr. Alvey’s nose. “No pulse and he’s not breathing. Starting CPR.”

Dr. Duncan leaned over Dr. Alvey and started chest compressions. The crunch of Dr. Alvey’s breaking ribs reverberated through the operating room. The circulating nurse held back sobs.

The code team burst through the doors and loaded Dr. Alvey on a gurney. Dr. Duncan jumped up on the gurney, straddled Dr. Alvey, and continued chest compressions as the team rushed to the Emergency Department.

Alicia turned back to the patient and resumed operating, a difficult task with trembling hands and tear-filled eyes.

Twenty minutes later, word made it back to the OR that Dr. Alvey was dead.

CHAPTER 2

POLO

I’m Michael Emmerson and I consider myself an involuntary connoisseur of human folly.

War and nineteen years of law practice gave me a thorough introduction to the topic, but nowhere was folly more prominently displayed than at the Imperial Polo Club in Indio, California.

Exhibit A: Seth Reyes. He was the guy you wanted to punch in high school. Perfect hair, perfect teeth, impossibly fit, brimming with easy-going confidence, billionaire parents, champion rider. All that at 17.

Seth sat on the white leather couch under the white canvas cabana at the edge of the field. He held a Coke and was dressed in a white polo outfit. He looked as if he were posing for a Lacoste catalogue. What made him look even better, and made me even more uneasy, was that my youngest daughter Carolyn sat next to him.

Like Seth, she wore a riding outfit and radiated the kind of natural brunette beauty any magazine would love to exploit.

Seth was telling Carolyn about how he and his brothers used to feed their dog crayons and then wait around all day for it to crap rainbows. My daughter laughed at the story, briefly forgetting she had standards, manners, and a brain.

“That’s why kids should be in school,” I said, “so they don’t do stupid stuff like that.”

“This was summer, Mr. Emerson,” Seth said.

“Summer school.”

Seth laughed off my comment. Carolyn shot me a look to say how much she appreciated me for condemning Seth’s vulgar behavior. Or perhaps it meant something else.

To protect my remaining IQ points, I stood, winced at the soreness from the bypass incision, and walked to the edge of the cabana where Seth’s father, Howard Reyes, looked out over the empty polo field.

Howard was everything his son was not. Short, balding, crooked teeth, and brilliant. Before joining the board of StriveNow—some secretive health program that he and my wife Jennifer were conspiring to make me join—he’d also been fat. Now he looked shriveled, but he exuded more energy than he’d generated in years. Whatever hippy dippy wheat grass shots or hot yoga nonsense he was into appeared to work.

I stepped beside Howard and looked across the field at the spectators. Polo was called the Sport of Kings because only kings could afford to play. But the peasants enjoyed watching, so for $10, they could drive their vehicles to the edge of the field and set up camping chairs, coolers, and beach umbrellas.

It was over this crowd of tailgate enthusiasts that Howard’s eldest son, Peter, flew his red and white Eurocopter EC135. He planned to fly low over the field in order to dry it with the helicopter’s downdraft. A dense and unseasonably damp fog had settled on the field during the night and rendered it too wet for the horses to play on.

I yelled over the chopper, “When you have a hammer, every problem looks like a nail.”

“The most expensive hammer of all time,” Howard said.

“We do what we can for our children. My daughter will ride half her inheritance onto the field.”

Howard laughed, then cringed as Hurricane Peter swept across the peasants and sent them scurrying after flying beach umbrellas and empty soda cans.

Peter lowered the chopper until it hovered two feet off the grass, then slowly circuited the field. The thumping whir of the helicopter made me nervous. I looked around to make sure everyone was safe. Thinking ahead to when the storm would make landfall on the ritzy side of the field, I said, “Let’s get ready to hold things down.”

We turned to the table that was heavy with catered food and a large sheet cake on which was written, “Happy Birthday Michael.” Howard weighted down the napkins and I set a casserole dish on top of the paper plates.

I was stretching plastic wrap over the cake when the chopper’s downdraft struck and peppered it with slivers of freshly cut grass. At least nothing flew off the table. I glanced over at the couch. Much to my disappointment, the fierce wind hadn’t blown Seth into another dimension.

 I should mention that it was my 49th birthday, a significant accomplishment considering that I died four weeks ago. But thanks to the grace of modern medicine, I was among the living, at least for a while longer.

Given the choice to be waterboarded or to throw a birthday party, I’d choose the more aquatic and pleasant experience. I’d said as much, but my wife insisted that all who cared about me wanted to celebrate that I still exist. My birthday happened to coincide with our daughter’s polo game in the Coachella Valley, so my wife decided to make one big day of it.

After the chopper passed, Howard busied himself restoring order to the table. I picked at the grass blades decorating my cake.

“When I was young, we played polo on horseback, not in helicopters.”

I looked up at the sound of the familiar voice and saw Miriam Haddad walking toward me.

“Off with the old.” I gave her a brief side hug. “This is a pleasant surprise.”

“Jennifer invited me. How are you feeling?”

“Never better. I wish I could have another heart attack.” I pointed at Howard. “This is Howard Reyes, owner of this fine establishment and also a client. Howard, this is Miriam Haddad, an old classmate of mine.”

As a habit, I didn’t mention Miriam’s profession because people invariably got weird and disgraced themselves by asking stupid questions or making lame jokes. Miriam was the Special Agent in Charge of the Criminal Investigative Division of the Los Angeles FBI Field Office. In government speak, the SAC of the CID of the LA FBI FO. Always in favor of clarity and efficiency, I’d suggested to Ms. Haddad on her recent 49th birthday that she shorten her title to Old Wrinkly SAC.

If Howard was struck by Miriam’s beauty, he hid it well. No doubt a conditioned response instilled by Mrs. Reyes. He shook Miriam’s hand, said something about having to talk with the polo ground’s manager, and walked off toward the clubhouse.

I wouldn’t blame Howard if he were smitten with Miriam. She was as striking as she was on the first day I met her at Stanford Law. She wore a grey dress made out of some sweater-like material that hugged her slender yet shapely figure. Her Lebanese heritage came through in her brown skin, high cheekbones, and thick black hair.

Miriam looked around. “Where’s Jennifer?”

“Some of our relatives are late. She’s in the clubhouse calling them.”

Miriam pointed toward the couch where Seth and Carolyn chatted and laughed. Their voices were drowned out by the sustained thunder of the helicopter. “Who’s that?”

“He’s a terrorist. The FBI should send him to Guantanamo until Carolyn is twenty-nine.”

Miriam smirked. “If he causes any trouble, the FBI is just a call away.”

While looking at the couch, I noticed my wife Jennifer walking up the side of the polo field. She wore brown leather riding boots, stylish jeans, and a light sweater that fit with the unspoken dress code of the polo elite. Her long, wavy blond hair fell from beneath a sun hat, its wide brim flapping in the helicopter’s downdraft.

Like Miriam, she also possessed a calm, assured demeanor and striking physical beauty. She ran several miles per day and did Pilates or something. I wasn’t an expert in such matters, as my rotting arteries and ample girth would attest. Perhaps, after I recovered from surgery, I would ask her to help me get in shape.

I needed to do something. During my recent follow-up, my cardiologist told me that I had a 75% chance of dying in the next ten to fifteen years. Those words had been burning in my mind ever since, keeping me in the cold grip of a low-grade panic.

As I watched Jennifer, I realized that something wasn’t right. Tension pulled at her lips and her pace was stiff and brisk. She stepped under the cabana and approached Miriam and me.

“I’m so glad you could make it,” Jennifer said as she hugged Miriam.

“Thanks for the invitation. I’m excited to see Carolyn play.”

“You should be. It’s amazing what she does. And terrifying at the same time. I have to close my eyes a dozen times per match.”

Jennifer turned toward me. “Babe, could you help me get something out of the car?”

I thought about reminding her that I wasn’t supposed to lift anything, but the expression on her face made me think better of it. “Of course.”

We walked toward the parking lot behind the club house. Once away from the cabanas, I asked, “What’s going on?”

Jennifer glanced around to make sure no one was watching. When she looked back to me, tears glistened in her eyes. “Teresa just called me back. Gerald died this morning.”