MUNICH, GERMANY

The Klinikum Rechts der Isar, Munich’s largest hospital, was also the city’s chief trauma center. No matter how often the roof was swept, grit blew into an eye-closing maelstrom whenever a rescue chopper landed on the designated helipad. Dr. Anika Klein shielded her face from the blast as the white MBB helicopter swooped over the building’s edge and settled on its skids. Her cotton scrubs rippled in the wind, flattening against her lean body as she fought her way toward the craft.

Okay, AK, let’s do it, Anika thought and ducked under the blur of blades. Two orderlies guiding an unwieldy gurney raced in her wake.

The helicopter’s side door crashed open and the life-flight paramedic jumped out holding an IV bag over his head, a thin coil of tubing trailing back to the patient’s arm.

“He went asystolic about thirty seconds ago,” he shouted over the turbine’s din. “This is the second liter of Ringer’s since the first ambulance reached the accident.”

Anika wasn’t listening. All she heard was that the patient’s heart had stopped. Right now everything else was details. Without waiting for the orderlies to transfer the stretcher to the gurney, she hopped up and straddled the accident victim, keeping her knees away from the blood saturating the sheets under his body. Pulling away the blankets, she noted his skin across his torso was deeply bruised, his ribs probably broken. She began CPR anyway, compressing his chest to keep his heart forcing blood through his body. Only when she had her rhythm did she once again pay attention to the paramedic.

“He was unconscious even while they pulled him from the car. Blood pressure’s too low to measure. His pulse has been thready since we took off.”

“What about his injuries?” she asked as the stretcher was maneuvered out of the chopper’s cargo area and onto the gurney.

“Both feet crushed, multiple tib-fib fractures in both legs. Right arm nearly severed, right clavicle fractures, lacerations to face, legs, and back. Pupils are nonreactive. Likely closed head injury.”

“Was he wearing a seat belt?”

“No.”

Anika finally looked at the face of her patient. He couldn’t have been more than twenty years old. “Asshole.”

She knew the driver would be coming to the hospital too. He’d be wheeled straight to the morgue, where his parents could claim him. He had been the same age as the man whose life Anika now held in her hands. An hour ago, they’d been playing Formula One driver on the Autobahn in a stolen Porsche. Now both were dead, though one had a slim chance of coming back.

Astride her patient like a jockey, Anika rode the gurney toward the waiting elevator, her upper body sawing with the beat of the CPR. An orderly had a ventilation bag over the patient’s face and forced air into his lungs in time with her movements. Once the elevator doors closed, she felt a sudden calm overcome her. It was always like this. For the first frantic moments she worked without thought, her training guiding her hands and her body. And now came the descent to the emergency room. She had forty seconds before the door opened again and until that time there was nothing she could do except maintain the CPR’s steady cadence. Her mind was freed.

It was the gift that kept her sane amid the carnage of negligence, stupidity, and increasingly, violence. Her eyes were on her hands, but her consciousness was focused on nothing at all. She was completely detached now, actually as calm as though she were in a trance. It was the same when she ran marathons. The last quarter of the distance was not run with the body but with the mind.

She became aware that her heartbeat was synchronized with her CPR.

The doors opened, and just as quickly the chaos returned. The orderlies wheeled the gurney down a bright hallway toward an open trauma bay. The life-flight helicopter had radioed information about the car crash victim during their inbound journey so nurses and another doctor were waiting. A portable defibrillator was standing by, and a nurse was poised with jelly and the electrodes for the heart monitor. Voices crashed above the sounds of electronics. Amid the pandemonium, Anika continued massaging the patient’s chest until everyone was ready to take over.

She shifted her weight so the heart monitor could be attached to his bare torso, its green line showing activity only when she compressed his body. When she stopped, he’d flatline once again. The gurney wheels were locked down, and an orderly stood to help Anika from the table, but she vaulted off like a longtime horsewoman, landing lightly on her rubber-soled shoes.

A nurse intubated him, running a direct oxygen hose into his mouth to keep his lungs working. The second doctor, Petr Heimann, had the defib’s paddles positioned in an instant. “Clear!”

The young man convulsed as electricity jolted his body. The heart monitor gave a matched spike but returned to a steady whine.

“Again,” Anika called.

The defibrillator charged and Heimann sent another blast through the dead man. This time a slow beat followed the spike.

Come on, come on, Anika silently prayed as she looked at his ruined legs, already thinking what would need to be done if they could get his heart beating normally. His pants had been cut away at the accident site, and even without X rays, she knew he’d lose both legs below the knees. One leg was held on by only a few ribbons of flesh. Tourniquets around his lower thighs were keeping back the blood and turning his skin a deathly gray. She imagined the gushes of blood that would pour from the ragged limbs when they’d release the thick rubber bands.

“He’s crashing again,” a nurse said.

Anika didn’t need to ask for epinephrine in a cardiac needle. Another nurse had it ready without being told.

The needle was long, an instrument better suited for a nightmare than a hospital, but Anika slid it between his ribs without pause, pressing it directly into the patient’s heart muscle.

Once she’d injected the drug, she removed the needle. “Shock him again.”

For the third time Heimann greased the paddles and applied them to the man’s naked chest, upping to 360 joules. At this stage, the dangerously high current couldn’t hurt him any longer.

“Clear,” he said with less anxiety. They all knew the outcome of this battle.

The jolt of electricity arched the patient’s back as though he was a bow being drawn taut. He fell back to the table, and somehow, miraculously, his heart began beating with an anemic rhythm. Anika and Petr began to work on the other injuries.

Checking his eyes, she discovered the pupils were pinpricks and did not respond to the penlight she flashed into them. He was in a deep coma. She ran her gloved hands through his hair and discovered a knot the size of an egg on the side of his skull. Closed head injury. They needed a CAT scan to determine the amount of brain damage. Judging by the other injuries, she believed it was safe to assume his head had taken a brutal pounding.

Anika crushed down her suspicions. Her job was to keep the patient alive long enough for the surgeons to take over. Once he left the ER, the future of the young joyrider was out of her hands.

“Tell radiology we need full trauma series X rays and a CT,” she told a nurse. “What do you think, Petr?”

“He’ll lose the legs even if he has enough mind left to control them.”

“The arm?”

Dr. Heimann glanced at the shattered limb. “Hamburger.”

The two doctors looked at each other, both silently thinking that maybe they should have called the patient when they had the chance. Was the Hippocratic oath meant to cover saving the life of a brain-dead triple amputee?

“Surgery is ready anytime we are,” a nurse announced.

“Okay, thanks.” Anika opened the tourniquets to allow blood to seep to the open wounds, returning natural color to the skin. Before the flow turned into a torrent she retightened the bands.

The patient’s heart rate was steady but shallow, and no matter how much saline they forced into him, his pressure remained low. He had internal injuries. Knowing the violence of the accident, Anika felt that some of his organs had likely detached, and that was where the bleeding was. A ruptured spleen was common with this type of crash. She sounded his abdomen and found it tight with the stress of blood filling the cavities.

She was about to confer with Heimann about a chest tube when the patient went into cardiac arrest for the third time. No matter how heroic the efforts, there was nothing they could do but watch him die. After a further ten minutes of frantic work Anika felt a touch on her shoulder. Petr’s stern eyes said enough.

“Call him.”

Angered, she looked at the wall clock, stunned to see they’d been working for a half hour. “5:18 P.M.” Her shift had ended eighteen minutes ago.

Anika stripped off her latex gloves and yanked the cloth cap from her head. More than anything she wanted to wash the sweat from her spiky black hair but there would be police outside the ER waiting to speak with her. The patient had been a criminal, after all.

As an emergency doctor, she knew the importance of distancing herself from her patients, yet losing even one pained her in a secret place she told no one about. She had to force herself to push back those feelings until she gained the perspective of time. Anika washed her hands in the scrub sink outside the trauma bay and changed into fresh scrubs in the doctors’ lounge, taking a moment to soothe her hair back against her head. In the mirror, her eyes were surprisingly clear considering what had just happened and that she’d just finished a twelve-hour Saturday-night shift. Heimann met her on her way out.

“Go start your vacation. I’ll handle the police and the paperwork.”

“Are you sure?” She was startled. Heimann wasn’t known for his bedside manner toward patients or coworkers.

“Ja.”

“Thank you, Petr. I owe you one.”

Anika decided to go to her apartment for her shower rather than do it at the hospital. She wanted to avoid Dr. Seecht, her boss, at all costs. She threw the laundry that had accumulated in her locker into a shoulder bag. Since her apartment was across the street from the huge medical center, she’d wear scrubs home.

Her mind was on the last-minute details she needed to finish before leaving for her trip. She had to get a key to her neighbor, a surgical nurse here at the Klinikum, so she could water the plants. She also needed to clean a week’s worth of leftovers out of her refrigerator. Then there was tomorrow’s trip to the town of Ismaning for her grandfather, and then on Monday it was time to leave for Greenland.

“Dr. Klein, just the person I wanted to see.” Dr. Heinz Seecht had been waiting in ambush outside the women’s changing room. “I was afraid you had already left.”

Damn. Anika had been avoiding Seecht for weeks. She knew what he wanted to talk to her about, and she was hoping to delay it until after the Greenland expedition. If she could, she’d put off this conversation indefinitely. Seecht was about to box her into a decision she still wasn’t ready to make.

“I was just leaving. My shift’s been over for a while.” A moment ago, she had been hyped up on adrenaline, but now she felt nothing but exhaustion. She crossed her arms over her small breasts.

“Yes, I just spoke with Petr. You lost the patient.” It was said with condescension, as if the kid’s death had been her fault.

Her body stiffened. “We did everything we could.”

“I’m sure you did,” Seecht said absently. “Petr’s a good doctor.”

By force of will, Anika remained silent. She and Seecht had been at odds since she first came to the hospital. He was nearly sixty and believed that only men made good doctors. His was an extreme form of sexism that was pervasive in Germany. However, now was not the time to lash out.

“I wish to be blunt with you, Anika,” Seecht said as though he’d been any different with her in the past. “Your performance is not up to the Klinikum’s standards and hasn’t been since you first arrived.”

Anika hadn’t suspected he’d take this tack and she was thrown off for a moment. She quickly recovered. Rather than let him complete his thought, she went on the attack. “It isn’t my skills as a doctor that are substandard,” she stated. “Every review places me near the top of all the trauma teams. I have been honored by the medical boards and I have been singled out by the mayor when his daughter came in with a ruptured appendix. I am more current on new techniques than anyone on your staff, and I did a year of ER work in Los Angeles before coming here. I saw more trauma in a weekend there than doctors here see in a month. So please tell me, in what way am I not meeting your standards, Dr. Seecht?”

She took a deep breath.

“I don’t question your surgical abilities.”

You’re goddamned right you won’t, Anika wanted to shout.

A pair of technicians approached from down the hallway, and Seecht touched Anika on the elbow to lead her away. She resented the touch. He wouldn’t have done it to a male doctor. He wouldn’t even have done it to a male janitor.

He continued when they were alone again. “There is more to being on my staff than skills. I demand dedication from my people, and that is something you lack. In your year and a half here, you have taken leaves of absence totaling six months. I encourage doctors to have interests outside their field, but not when it interferes with their work. Your little adventures have become such an interference, I’m afraid.”

“My little adventures,” Anika snapped acidly, “have given me the research material for two published papers on the chemistry of stress.”

Seecht was not impressed. “You were not hired to be a research doctor. And even if you were, you didn’t need to go on a four-week climbing expedition to the Himalayas to gather that information and you know it. The papers you write are just your excuse, your cover story.”

He spoke as though on a telephone, looking at a spot over her head so he didn’t see the aggressive flare in her eyes. It was at times like this she hated being just over five feet tall. In a confrontation, being short gave others a perceived advantage. Seecht needed only glance over her head and he completely isolated her from the conversation.

Anika wanted to deny his accusation, but she would never outright lie to Seecht. He was right. Writing papers was her way of legitimizing the fact that she wanted to go away to climb mountains or trek through jungles.

Seecht finally looked her in the eye. “I wanted to catch you before you left for the Arctic or wherever it is you’re heading and let you know that you have a decision to make. You will be gone for three weeks, and when you get back you will find that my patience has run out. There will be no more trips or expeditions or anything else. You will work every shift I assign to you without complaint or you will find yourself without a job. Do I make myself clear?”

She had long known that she had a decision to make, one that would doubtlessly affect the rest of her life. She didn’t need this misogynist to point it out to her.

“Do you understand, Dr. Klein?” Seecht repeated more forcefully.

“I understand.” No matter how bitter the words, she wouldn’t turn away from him as she said it.

His voice softened. “You have the makings of a fine doctor, like your father. Don’t throw it away because you want to go play in the mountains. It is time you grew up and faced the responsibilities of your profession.”

To anyone overhearing the conversation it would have sounded as though Seecht was being understanding. In fact, evoking her father was an attempt to cut her as deeply as possible. Anyone who knew her understood how much her memories of her father meant to her. And how it was his footsteps as a doctor she now followed.

Without another word, Seecht retreated down the hall, leaving Anika amid a storm of emotions. Being fired wasn’t what bothered her. With her credentials she could work anywhere in Germany or the rest of the world for that matter. It was the decision that upset her. Did she want to stay in medicine and honor her long-dead father or would she leave to pursue her own interests?

With an angry shake, Anika cleared her head, refusing to allow this to dampen her enthusiasm for the upcoming Greenland expedition. Although three weeks at a remote Arctic research station were far from the toughest challenge she’d faced, she felt the old stirrings of excitement already pushing aside Seecht’s ultimatum. Something told her that the answer to her dilemma was waiting on the Arctic wastes and she was eager to see what it would be.