Chapter 2 — A Wound Without a Record

Claire covered Dominic before the bedroom door opened.

Elias Varela entered in a charcoal coat, followed by a broad man carrying a medical case. Elias had Dominic's dark eyes and none of his exhausted vulnerability. He took in Claire, the phone beside her, and the open chart.

"I was told the agency sent one nurse," he said.

"The other left."

"Perhaps you should join her."

"Your brother needs emergency care."

The man with the case stepped forward. "I'm Dr. Simon Kessler. I know his condition."

"Good," Claire said. "Then tell me why the incision on his lower back isn't in the discharge report."

Kessler stopped. Elias looked at him before he looked at Claire. It lasted barely a second, but she saw it.

"There was a minor follow-up procedure," Kessler said.

"On which date? With whose consent?"

"That information is in my office records."

"It's absent from the records supplied to the people caring for him. He has a fever and neurological symptoms. Call your office and have the records sent to the receiving hospital."

Elias smiled without warmth. "My brother has refused the hospital."

"He just asked me for help. He also said he did not know about surgery on his back."

"My brother is delirious. You are a temporary employee."

"Neither statement makes the wound disappear."

Elias turned to Marcus. "Did you see her find it?"

"Yes."

"Did she do anything to the skin first?"

Marcus stared at him. "She cleaned it."

"With what?"

Claire understood the question before Marcus did. "The wound was there when I arrived. I photographed it before and after cleaning. The original files have time stamps."

Elias's eyes narrowed. He had wanted Marcus to suggest that Claire had caused the damage. Marcus looked from one face to the other and seemed to reach the same conclusion.

Elias held out his hand. "The phone, please."

Claire kept it beside her. Marcus moved closer to the bed, a small change in position that placed him between Dominic and Kessler.

"It's an agency device with his care records," Claire said. "You can speak to the agency about access."

"You photographed him without family permission."

"He permitted the examination. And if you're worried about the photographs, ask why they were necessary."

Kessler set his case on the dresser. "I can examine the wound."

"You can tell the hospital what you did," Claire said.

Elias's smile vanished. "Marcus, remove her."

Marcus did not move.

"I hired you," Elias said.

"Dominic signs my checks," Marcus replied.

Dominic pushed himself higher against the pillows. The effort left him shaking. "She stays."

The room fell quiet. Elias recovered first.

"You're not well enough to understand what is happening."

"I understand you want her phone." Dominic looked at Claire. "Keep it."

Elias glanced toward the door. Claire could almost see him weighing the witnesses. He told Kessler to stay, then walked out with a promise to find the consent form.

The instant he was gone, Claire handed Marcus a written list of Dominic's vital signs and the hospital request. "Give that to the ambulance crew. Don't let anyone direct them upstairs without you."

"I called dispatch," he said. "They're sending a crew."

Claire went to the bathroom, locked the door, and used her personal phone to message Leah Price. Leah had worked beside her in trauma surgery and was now an emergency physician across town. Claire sent the wound photographs, the discharge summary, the vial label, and a short note:

Patient febrile, worsening leg weakness. Undocumented lumbar incision. Ambulance requested. Preserve these if my phone is taken.

Leah replied almost at once:

Received. Which hospital?

Claire named the one dispatch had given Marcus. Leah said she would alert its emergency department and ask that the images be added to the incoming patient's record. Claire saved the reply and returned to the bedroom.

Before leaving the bathroom, she took one photograph of the agency's medication chart as well. Her own name appeared beside only the assessments she had performed. An unsigned entry at the bottom instructed the next shift to avoid discussing Dominic's leg weakness in his presence because it upset him.

It had the opposite effect on Claire. The chart was supposed to tell caregivers what they needed to know. Someone had used it to tell them what they should stop asking.

Kessler was leaning over Dominic with a syringe.

"What is that?" Claire asked.

"Something to keep him comfortable."

"Name and dose."

Kessler read the label aloud. Claire checked it against the medication record and saw that no new order had been entered. She held out the chart.

"Write the order before you give it. His breathing is already shallow."

His expression tightened. He put the syringe back in its case.

"You used to be a surgeon," he said.

Claire looked at him. "We haven't met."

"People in medicine talk."

"Then you know why an unrecorded operation concerns me."

Elias returned carrying a thin folder. He opened it to a page bearing Dominic's name and a signature. The heading authorized treatment for an infection associated with the shooting.

"There," Elias said. "He signed it at the clinic."

Claire did not touch the page. She photographed it where Elias held it, including the date and the form number. Dominic's writing appeared on the consent line, but Claire had no sample for comparison. More troubling was the description of the procedure: a broad phrase that mentioned neither the lower back nor the spine.

"This doesn't explain the incision," she said.

"It authorizes necessary treatment."

"Then the procedure note will show what was necessary. Where is it?"

Elias snapped the folder shut.

Dominic raised one trembling hand. "Let me see."

Elias stayed where he was. Claire watched Dominic's expression change. He was frightened; the anger came afterward.

"Give it to me, Elias."

At last Elias set the folder on the bed. Dominic turned the page slowly. His thumb stopped beneath the signature.

"I signed a form for my shoulder," he said. "This date is two days after I left the clinic. I wasn't there."

Kessler looked down at his case. Elias reached for the folder, but Dominic kept his hand on it.

"Who signed this for me?" Dominic asked.