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  L i f e l i n e s

  CJ Lyons

  “[A] spot-on debut . . . a breathtakingly fast-paced medical thriller.”

  —Publishers Weekly

  “CJ Lyons writes with both authority on her subject and a down-to-earth reality for her characters, making Lifelines an exciting debut novel for this author. Engrossing, intrigu-ing; I will be looking forward to all her work in the future.”

  —New York Times bestselling author Heather Graham

  “If you’re looking for tense, whip-smart medical scenes, look no further. Lifelines takes you into the ER for a gripping view of doctors at work, and doctors in crisis. CJ

  Lyons knows her medicine—and she knows how to bring it to vivid life on the page.”

  —Tess Gerritsen, New York Times bestselling author of The Bone Garden

  “Forget about your plans for the day and prepare to be swept away on a pulse-pounding adventure. This is my favorite kind of medical thriller—harrowing, emotional, action-packed and brilliantly realized. CJ Lyons writes with the authority only a trained physician can bring to a story, blending suspense, passion, and friendship into an irresistible read.”

  —Susan Wiggs, New York Times bestselling

  author of Snowfall at Willow Lake

  “A pulse-pounding adrenaline rush! Loved the pacing, loved the characters, loved the whirlwind action scenes and top-notch medical details. Reminds me of ER back in the days of George Clooney and Julianna Margulies . . .

  hurtles the reader through a roller-coaster ride of suspense.”

  —Lisa Gardner, New York Times bestselling author of Hide c o n t i n u e d . . .

  “It takes a real emergency physician to write this excitingly about an emergency ward. CJ Lyons has been there and done it. The pages are packed with adrenaline. I can’t recall a hospital novel that so thrilled me.”

  —David Morrell, New York Times bestselling

  author of First Blood and Creepers

  “CJ Lyons’s debut medical thriller is a fantastic and wild journey through the fast-paced world of a big-city ER.

  With rich, fascinating, and complex characters and a thoroughly compelling mystery, Lifelines is an adrenaline rush and an all-round great read.”

  —Allison Brennan, author of What You

  Can’t See and Killing Fear

  L i f e l i n e s

  CJ Lyons

  THE BERKLEY PUBLISHING GROUP

  Published by the Penguin Group

  Penguin Group (USA) Inc.

  375 Hudson Street, New York, New York 10014, USA

  Penguin Group (Canada), 90 Eglinton Avenue East, Suite 700, Toronto, Ontario M4P 2Y3, Canada (a division of Pearson Penguin Canada Inc.)

  Penguin Books Ltd., 80 Strand, London WC2R 0RL, England Penguin Group Ireland, 25 St. Stephen’s Green, Dublin 2, Ireland (a division of Penguin Books Ltd.) Penguin Group (Australia), 250 Camberwell Road, Camberwell, Victoria 3124, Australia (a division of Pearson Australia Group Pty. Ltd.)

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  Penguin Books (South Africa) (Pty.) Ltd., 24 Sturdee Avenue, Rosebank, Johannesburg 2196, South Africa

  Penguin Books Ltd., Registered Offices: 80 Strand, London WC2R 0RL, England This is a work of fiction. Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to actual persons, living or dead, business establishments, events, or locales is entirely coincidental. The publisher does not have any control over and does not assume any responsibility for author or third-party websites or their content.

  LIFELINES

  A Berkley Book / published by arrangement with the author Copyright © 2008 by CJ Lyons.

  Interior text design by Kristin del Rosario.

  All rights reserved.

  No part of this book may be reproduced, scanned, or distributed in any printed or electronic form without permission. Please do not participate in or encourage piracy of copyrighted materials in violation of the author’s rights. Purchase only authorized editions.

  For information, address: The Berkley Publishing Group, a division of Penguin Group (USA) Inc.,

  375 Hudson Street, New York, New York 10014.

  ISBN: 1-4362-0636-7

  BERKLEY®

  Berkley Books are published by The Berkley Publishing Group, a division of Penguin Group (USA) Inc.,

  375 Hudson Street, New York, New York 10014.

  BERKLEY® is a registered trademark of Penguin Group (USA) Inc.

  The “B” design is a trademark belonging to Penguin Group (USA) Inc.

  Dear Readers,

  No writer makes it into publication without help. Make that without a lot of help. And so, I’d like to thank some of the people responsible for the book you are holding in your hands.

  First, to my guardian angels: Anne Hawkins and Joe Hartlaub.

  You not only inspired and guided me, but you also believed in me from the start.

  To my astute and eagle-eyed critique partners: Margie, Toni, Car-olyn, Kim, and Debra. To Donna and David for their wonderful advice and the fictional use of their cat. To Eileen and Bob for their gracious hospitality and unwavering support. To all my friends and family for their encouragement and warm thoughts.

  Thanks to all of you. I couldn’t have done this without you!

  Also, to all the fantastic folks at Berkley including Kathy Kleider-macher who found our title; Amy Schneider who actually made copyedits fun; my fantastic and ever-patient editor, Shannon Jamieson Vazquez; and to Susan Allison and Leslie Gelbman. I’ll be forever grateful for the trust you have placed in me.

  To my patients and their families, my medical and EMS colleagues, as well as the law enforcement personnel I have worked with. You have all taught me the true meaning of courage.

  Medical protocols change frequently, so I went to an expert to ver-ify that I had the most accurate and up-to-date information.

  Thank you, Laurie J. Weaver, RN, BSN, EMT-P, EMT-I for your technical assistance. Any mistakes are mine, not hers.

  Pittsburgh is one of my favorite cities, so I apologize in advance for redesigning some of its geography to suit my fictional needs.

  I’ve also taken a few liberties with medical and legal procedures.

  Honestly, if I described a real-life resuscitation in minute detail, you’d be bored to tears.

  Finally, I’d like to thank you, my readers. Thanks for taking a chance on a newcomer! I hope you enjoy reading about the behind-the-scenes action at Angels of Mercy as much as I enjoyed writing it.

  I’d love to hear your comments. Feel free to contact me at www.cjlyons.net.

  Thanks for reading!

  CJ

  O N E

  Monday, July 1, 6:45 p.m.

  July 1st. The most dangerous day of the year.

  Transition Day, the day newly graduated medical students arrived to begin their internships, freshly scrubbed, wearing long white lab coats instead of their short student jackets.

  And absolutely no smarter than they were on June 30.

  Dr. Lydia Fiore knew all about the dangers of Transition Day. People died on Transition Day.

  Starting her new job today, of all days, was not a good omen.

  Yet here she was, pacing outside Pittsburgh’s Angels of Mercy Medical Center, its shiny steel-and-glass patient care tower looming over her.

  She blinked hard, tried not to imagine herself running along the beach, the Pacific stretching out to infinity beside her. She’d left Los Angeles behind. Pittsburgh was home now.

  She stopped beside the main ER doors
, beginning to wonder if this was such a great idea after all. Her stomach did a tumble and roll, like being sucker punched by a wave off the coast at Malibu, dragged under by your own stupidity.

  Lydia remembered her own Transition Day, back in L.A. Her time on the streets working as a medic had given her an edge—an edge quickly erased with her first failed resuscitation.

  Ain’t no cure for death, the ER’s charge nurse, a woman who had been in the trenches for thirty years, had told her back then, smirking at yet another intern’s ego successfully sliced and diced.

  What Lydia had never understood until now was that as harrowing as med school, internship, and residency were, nothing in life was more terrifying than stepping into the role of attending physician. Boss. The buck stops here. The one in charge, the one responsible, the one most likely to be sued if anything went wrong.

  The screech of brakes, honking of horns, blare of sirens, and stench of diesel fumes smothered her in a blanket of humidity. Pittsburgh smelled a lot like L.A. Shoving her jagged bangs back from her face, she bounced on the balls of her feet, ready to take the plunge.

  Attending physician. As in attending to the needs of all the patients and their loved ones and the staff and the residents and the medical students and, if there’s time, catch up on charting, quality assurance, research, lecture preparation, public relations, committee meetings, continuing medical education, and oh yeah, don’t forget to be nice to the volunteers and auxiliary members while you’re making those life-and-death decisions.

  An air-conditioned breeze escaped through the ER’s open doors, bringing with it the familiar sounds of urban trauma. Footsteps clattering, a baby crying, voices colliding.

  A siren’s call to Lydia. Her toes curled in anticipation, eager to push off from a high cliff. Ready or not, this was her new life.

  As Lydia was getting the sign-out from Mark Cohen, the attending she relieved, a petite, red-haired woman in her twenties joined them, waving her trauma radio to catch their attention. “Fourteen-year-old, full arrest coming in by squad.”

  Mark frowned. “I’ll stay, see you started.”

  “No. Mark, go home.” He’d just finished working a twelve-hour shift and looked exhausted. Lydia was certain she could handle anything Pittsburgh had to offer. It wasn’t like she’d be on her own. There were residents, other attendings, a hospital full of subspecialists. “I’ll be fine.”

  “All right, if you say so.” He turned to the redhead and made introductions. “Nora Halloran, your charge nurse for the night. Nora, have you met Lydia Fiore, our new attending?”

  “Nice to meet you, Dr. Fiore.”

  “It’s Lydia, please.”

  Nora didn’t waste time shaking hands. Instead, she donned a pair of polycarbonate protective goggles, making it clear she intended to personally supervise the new attending’s first major case. She nodded to Mark, then hustled down the hall, rounding up her troops.

  “I guess this is yours.” Mark handed Lydia the trauma radio, the symbolic passing of the baton that accompanied all shift changes. “Call me if you have any problems. Good luck.”

  Lydia clipped the small radio onto her belt and tugged the drawstrings of her scrub pants tighter. Her pulse revved up in anticipation as the familiar weight settled on her hip.

  She jogged the first two steps, then forced herself to slow to a fast walk, heading toward the ambulance bay to meet the paramedics and her first patient.

  “Fourteen-year-old male found in full arrest at Schenley Park,” a medic called out as they rushed a sandy-haired teen strapped to their stretcher down the hall. The second medic rode on top of the gurney, straddling the boy, performing chest compressions amid the remains of a Buckcherry T-shirt that had been cut away to allow placement of EKG electrodes.

  They quickly arrived in the critical care room. Lydia helped her team transfer the teenager to the ER’s bed.

  The first medic—Trey Garrison, according to his name tag—glanced up, revealing a pair of vivid hazel eyes that locked onto Lydia’s gaze. Bagging oxygen into the boy’s lungs, he didn’t falter in his rhythm as he shifted places so Lydia could check breath sounds with her stethoscope.

  The hum of contentment mixed with adrenaline sparked an electrical tingle that radiated throughout her body. She loved it when a resuscitation flowed almost effortlessly, as if it were choreographed. Trey read her mind, handing her an ophthalmoscope before she could ask for it.

  “His friends said he was fine, then suddenly got a frightened look on his face, jumped up, ran about twenty yards and collapsed. One of them began CPR at the scene. We found him in v-fib, shocked him without results, one round of epi, shocked again, and loaded with lidocaine.” Trey’s tone was grim, with good reason. The prognosis of an arrest unresponsive to epinephrine and defibrillation was worse than poor.

  Ain’t no cure for death.

  “Drug use? Any past history?” She glided her hands over the now naked teen’s body, searching for any trauma or other reason for his sudden collapse. Her vision tunneled to center on her patient, her focus drowning out all sounds except the information her team provided. In the zone.

  “Friends said no, but we saw a couple empty cans of beer. They said he’s healthy.”

  “Shock him at three-sixty,” she ordered, “then load him with amiodarone.”

  “He’ll be due for another round of epi,” Trey’s partner put in as he hauled his stretcher out of the room, freeing up space for Lydia’s team to work. He returned to stand in the corner. She felt his, Trey’s, and Nora Halloran’s gazes on her as she finished her assessment. Wondering about the new doc in town, no doubt.

  Lydia backed away from the bed to gain a better perspective—the big picture. A nurse delivered the shock to the electrode pads. No change, still v-fib.

  “His name is Theo Pearson,” Nora announced, pulling a thin nylon wallet from the pocket of his shorts. Lydia spared a glance at the charge nurse. She was even shorter than Lydia’s five-five and looked pretty young to be in charge of an ER this size.

  Lydia watched the monitor as the amiodarone was pushed, followed by another round of electricity. Her foot tapped in time with her own pulse in an unconscious attempt to spark Theo’s heart into the same steady rhythm. The dancing green lines that represented the electrical activity in his heart spiked erratically before finally resolving themselves into a regular pattern.

  “V-tach. Do we have a pulse?” she asked.

  “No pulse,” Trey announced after palpating the carotid area. Trey’s partner resumed CPR, relieving the nurse.

  Lydia bounced on her toes, doubt breaching her defenses, releasing a stream of nervous sweat trickling down the back of her neck. Ventricular tachycardia was theoretically better than ventricular fibrillation, but no pulse was still dead.

  She sped through the possible causes of arrest. For a healthy fourteen-year-old, drugs like cocaine or crystal meth were high on the list. Until the tox screen came back there was little she could do except run the cardiac arrest protocol.

  Much as ER docs loved guidelines and protocols, Lydia knew they were really a mask to hide the real truth about medicine on the front lines—that doctors pretty much made it up as they went along.

  Except Lydia was running out of ideas. And time. “How long has he been down?”

  Trey glanced at the overhead clock. “Coming up on seven minutes.”

  She squeezed one hand tight into a fist, then released it as if flinging away pessimistic thoughts. Damn it, she hated losing. Even worse, losing a kid.

  “Hang an amiodarone drip, defibrillate again at three-sixty, and give another epi.” She moved to the head of the bed, brushing against the paramedic.

  After the jolt of electricity finished arcing through her patient, she performed a complete reassessment. When in doubt, start from the ABCs: airway, breathing, circulation.

  She needed to find something to treat. The boy had been without oxygen for too long; if she was going to get him back it had t
o be now.

  The odds were against her and her patient. Full arrest in the field, not responding to electricity or meds—Lydia had better odds of winning the lottery without buying a ticket.

  “He’s back in v-fib,” Nora announced.

  She was losing him. Lydia leaned forward to listen to his breath sounds again. Then, stopped, sniffing. What was that, Pine-Sol? No, it smelled more like a new car. She straightened and looked at Theo’s face. Around the tape of the endotracheal tube, beneath his nose and around his mouth, a red rash like prickly heat mottled his skin.

  “Hold that epi,” she told Nora as the nurse was preparing to push the stimulant into the IV. “Get me propranolol, one milligram.”

  The room quieted. Lydia tore her attention away from her patient and saw Trey staring at her. He stood, arms crossed as if waiting to complete his own assessment on the new doc.

  “Dr. Fiore, I don’t think that’s what you want,” Nora said in a tone implying that Lydia was clearly out of her league.

  Lydia straightened, met the charge nurse’s gaze across the table, the patient between them. Everyone was silent, watching to see who drew first blood.

  Nora stepped closer and laid one hand on the patient’s arm as if protecting him from Lydia.

  “Do as I say. Give him the propranolol.”

  “That’s not AHA protocol, Dr. Fiore,” Nora said in a firm voice, her cheeks flushing so that they almost matched her red hair. A nurse didn’t outtrump a physician, especially not an attending physician, yet everyone in this tight-knit team clearly deferred to Nora’s authority. “The American Heart Association has set guidelines for a pulseless arrest.”

  Pittsburgh charge nurses were no different from L.A.’s.

  They truly believed in protocols—just as they lived for paperwork, preferably done in triplicate.

  Lydia grabbed the vial of propranolol from the crash cart and filled a syringe with the proper dose. “We don’t have time to argue.”

  “Epinephrine is the drug of choice—” Nora put in.

  “If you give him that epi, he’s dead.”

  It was kind of nice for once being the person

  who knew it all, Amanda Mason thought as she watched the new emergency medicine interns report for their first shift. Unlucky stiffs had been assigned the overnight shift.