Join New York Times Bestseller and real life ER physician CJ Lyons as she returns to her medical thriller roots with a heart wrenching tale of good and evil, despair and hope, and the unexpected gift of grace that comes with embracing our mortality.
In the chaos of the ER, functioning without sleep is a prized skill. But even Dr. Angela Rossi will admit that five months is far too long. Then a dead nun speaks to her while Angela is holding the nun's heart in her hand. "Find the girl
The girl IS real. The threat to her is deadly.
Aided by a police detective fallen from grace, Angela searches the midnight catacombs beneath the city, facing down a ruthless gang leader and stumbling onto a serial killer's lair. Her desperate quest to save the girl leads her to the one thing she least expected to find: a last chance for love. As her symptoms escalate in bizarre and disturbing ways, Angie realizes exactly how serious her illness is. She might be dying, but she's finally choosing how to live…
C.J. Lyons is the classic renaissance man, if by "renaissance man" you mean "modern, accomplished woman." She's an ER doctor, a mega-bestselling author, has assisted law enforcement in homicide and sexual assault cases, and, like Lawrence Block, is unfailingly kind and generous with her time. She graciously agreed to an interview on my blog a couple of years ago and provided me with some of the most thoughtful answers I've ever encountered. We're lucky to have her in this Action/Adventure bundle with a medical thriller you'll probably want to devour in one sitting. – Allan Leverone
"CJ Lyons scores a major triumph with FAREWELL TO DREAMS. Totally absorbing and impossible to put down."– Douglas Preston, #1 NYT bestselling author
"FAREWELL TO DREAMS has it all: a heroine you'll never forget and a story that whips by at bullet speed."– Tess Gerritsen, NYT bestselling author
"Everything a great thriller should be—action packed, authentic, and intense."– New York Times bestselling author Lee Child
"A compelling voice in thriller writing…I love how the characters come alive on every page."– New York Times bestselling author Jeffery Deaver
I'm Angela Rossi. I'm thirty-four years old, and this is the story of how I die.
I'm an ER doctor and victim's advocate—make that former ER doc—and this is the story of how I live.
Most of all, it's a story of redemption.
Guess it all depends on your point of view…
Even if it's a rainy Thanksgiving night with the ER's waiting room overflowing and all of our exam rooms filled, cops and firemen will always get first dibs on our attention. They may have to wait if others are closer to death, but they're going to get seen and seen fast.
Here at Cambria City's Good Samaritan, the only trauma center still standing in this corner of Pennsylvania's Allegheny Mountains, we know how to treat our friends, and when you work on the front lines in the ER, first responders are more than friends, they're family.
So when I grabbed the next chart stacked in front of the overflowing rack and saw a cop's name there, I was surprised.
Like most of my colleagues, my job encompasses more than simply working shifts in the emergency department. I'm also medical director of the Cambria Advocacy Center, in charge of forensic evaluations of victims of violence. More than collecting evidence and assisting the police with their investigations, we also provide support and counseling to victims.
Matthew Ryder's name had come across my desk as the replacement for the detective who had been working with us. Poor guy had driven off an icy bridge and died. But I hadn't expected to first meet our new detective as a patient.
I glanced at the registration time on the chart: 17:02. Ryder had been waiting almost three hours already.
"Why didn't you guys tell me there was a police officer waiting?" I asked the clerk at the nurses' station. "I could have eyeballed him between the MI we sent up to the cath lab and the guy stabbed with the drumstick." Drumstick Guy had made our night. ERs are like that; our fun begins when yours ends.
"He didn't want to bother you. Said he was in no rush."
Great. Despite what he said, no cop would take kindly to waiting three hours. Especially not with the ER as crazy as it was tonight. Trust a family holiday to bring out the worst in everyone.
"I did put him in front of the minor cares, especially when I saw all the blood." His words were underscored by the wailing of yet another ambulance arriving. My shift ended an hour ago, which meant the ambulance was someone else's problem, but the least I could do was take care of Ryder—and check out the detective I'd be working closely with starting next week.
Scanning Ryder's chart, I wove my way around two patients parked in wheelchairs outside of X-ray and a family member pacing as he talked on a cell phone.
Amazing what a triage note can tell you about a person. Scalp laceration. Good vitals. Thirty-seven years old, no meds, no allergies, 182 pounds, single. I pulled back the curtain to Ryder's bed space.
Instead of lying on the patient bed, Ryder straddled the rolling office chair meant for physicians, watching the next bed space through an opening in the curtain, his back to me.
"They're scared," he said without turning around.
His voice was pitched low, but had no trouble carrying to me, its intended target. It was that kind of voice. More like a bullet, direct and forceful, than an invitation. His posture was relaxed yet commanding, perfect for a cop or soldier. As if he owned the space, the room, the entire emergency department.
The area beside him was occupied by a family gathered around an elderly woman, wringing their hands, arguing with each other in English peppered with Hungarian. Back when the Pennsylvania Railroad was in its heyday and the coal mines still producing, Cambria City's diversity once rivaled Ellis Island's. We're still multicultural, but in the current economic plight, the majority of our citizens now speak the same language: welfare.
Ryder turned and glanced at me. The chart hadn't mentioned his blue eyes, so blue they couldn't be ignored. Blood seeped through the towel he pressed casually against the side of his head. Scalp lacs are like that, bleed like stink.
"You should talk with them. Tell them she'll be all right." He didn't give me a chance to argue, seemed to assume we were in agreement and that he was in charge. "I'll wait."
I washed my hands and gloved up, choosing to ignore his presumptive attitude. I'd spent most of my twelve-hour shift helping the Kowaczs: arguing with their HMO, negotiating with my fellow doctors for space, kissing the charge nurse's butt when the entire clan descended upon us. "She won't be all right. She's dying."
"Damned undignified way to do it. Can't you give them some privacy?"
It was impossible to ignore his stare or the force behind it. If I hadn't been so exhausted after the long day, I might have given in and let loose my anger at his impertinence. Instead, I broke free from his gaze and yanked the curtain closed.
"Best I can do for now." A sudden tremor in my left hand distracted me. Damn it, not again.
I'd had problems for the past few weeks, on and off, but chalked it up to overwork, stress, and exhaustion. It'd been since before summer that I'd had a full night's sleep or done more than toss and turn, my limbs restless with the urge to move, move, move. Fatigue I could handle, one of the many skills any ER doc masters. But even a slight tremor could be a problem. A twitch or shake at the wrong moment, say, with your hand holding a scalpel, could be devastating.
My best friend, Louise Mehta, is a neurologist, so I'd promised myself that if the tremor continued or if things got worse, I'd let her check me out. Clenching my left hand at my side, I willed the spasm away. If I could make it stop, then things weren't worse and I could continue to ignore my symptoms.
The tremor wasn't cooperating. Much like the patient before me. "Why don't you lie down on the bed so I can examine you?"
"No, thank you. I'm fine here." He pushed the chair out of reach, preferring a confrontation to an examination. "Why?"
Now both my hands were fisted at my hips, and it had nothing to do with any tremor. "Why what? Why use the patient exam bed for an examination?"
"Why is that the best you can do?" His tone wasn't judgmental. Quite the opposite. As if he genuinely cared about the Kowaczs or my problems. But it had been a hard day, and Ryder was unlucky enough to become my last straw.
"Because I'm a sadistic, heartless bitch who couldn't give a shit. Why do you think? Maybe because there are no open beds in the hospital, and even if there were, we have no nurses to staff them, and even if we did, the Kowaczs' insurance doesn't cover hospice or end-of-life care."
He held my gaze during my tirade, steady as an anvil absorbing hammer blows, finally blinking when I stopped to take a breath. "Feel better now?"
My sigh turned into a chuckle as my mood lightened. My tremor disappeared as well. See? Nothing to worry about. "Yes, I do. I'll feel even better if you tell me what happened and let me examine you."
"It's stupid, really." He removed the towel to reveal a two-centimeter gash above his temple. His flannel shirt and the T-shirt beneath it were splattered with blood. "You know when you're microwaving those frozen dinners and they say remove to stir halfway? I left the door to the microwave open and hit my head on the corner when I went to put the dinner back in."
"Did you burn yourself or black out?" I explored the laceration. Superficial, a few staples would close it nicely.
"It's Thanksgiving, and you were home alone having a frozen dinner?" I poured Betadine over his wound, releasing the sour scent of iodine into the small space.
"Now who's wasting time with questions that have nothing to do with medicine?"
"Just checking your mental status, seeing if you have any psych problems." Despite my exhaustion, I enjoyed the banter. He was easy to talk to—a plus for a Sex Crimes detective. Interesting that he hadn't played the "policeman" card. I was relieved to see my fingers completely steady as they guided the hair-thin, 27-gauge needle along the edges of his wound, infiltrating it with lidocaine.
Before he could answer, the curtain flipped open, its cheerful rattling a sharp counterpoint to the chorus of coughing coming from the hallway beyond it.
"Angie, we need to talk."
If Ryder's voice was one of quiet command, my ex's was gentle persuasion, smooth and warm enough to make you turn as if searching for sunlight to bask in. It was Jacob's strength both in and out of court, and the one thing about him I could seldom resist.
"I'm a little busy." I glanced up at Jacob, then immediately forced my gaze away, knowing what he wanted. Despite being divorced for three—no, four—years, we're still close and usually fall together again around the holidays. Two lonely people who share a past and know how to comfort each other.
He stepped into the room, the curtain whishing shut behind him, blocking out the chaos of the ER. Tall, lean, with a mop of curly dark hair and a gaunt, narrow face, Jacob radiates intensity. He makes you want to listen to him, look at him, agree with him. A snake charmer, his cohorts at the DA's office call him. I concentrated on filling my irrigation syringe, as if the simple four-second task required all my attention.
"Your mother sent me to bring you."
That got my attention. It isn't often that Jacob lies—although, for a rabbi's son, he can do it surprisingly well. Learned how in law school. When he does lie, it's never self-serving. This time it was easy to see whom he was protecting. And it wasn't me. My ex-husband is closer to my family than I'll ever be. To tell the truth, he's closer than I ever was—at least not since I was twelve and my father died.
Killed. In a car crash. My fault.
My dad, Angelo… I'm like him in every way. Same dark, Italian looks, same incessant fidgeting, unable to sit without tapping a song out with my fingers or toes, unable to walk anywhere when I could be running. Restless, unable to just… be.
Those qualities had made my dad the life of the party, loved by everyone. And me? I killed the man who was my mother's entire life, the man who could make her laugh and cry and laugh again all in the space of a single heartbeat. Every time my mom looked at me, that's who she saw.
It's been twenty-two years since my dad died. I glanced up at Jacob, wishing he were telling the truth, that my mom did send him to ask me to join the family. That she wanted me. There, alongside my sister and cousins and the laughter and joy. Silly, wistful thinking. You'd think an ER doc would know better. "No, she didn't."
He didn't waste any breath with a sigh. "All right, she didn't. But everyone else did."
My shoulders hunched in regret, I turned my back on Jacob to aim a stream of sterile water at Ryder's laceration.
"Hey, that's cold," he protested, but he didn't flinch or move away as I doused him and his shirt. That's what he got for insisting on sitting up in the chair rather than lying down.
"Your shift was over at seven, and it's now twelve after eight." Jacob tried again. He's almost as stubborn as I am. "C'mon. It'll be fun. The whole band is there. Besides, you look tired. Play a few sets with us. It'll work the kinks out."
By that, I knew he meant we'd work some kinks out, after my uncle's bar closed down for the night and everyone went home. Usually, I enjoy playing fiddle in the ceili band my father had founded. Just as I usually look forward to the physical intimacy Jacob offers. But not tonight. Jacob knew me far too well. My secret wasn't safe from him. If he noticed my night sweats or tremors or the sudden stumbles as my feet forgot which way was down, he'd be pounding on Louise's door, holiday or no holiday, and insist I get a head-to-toe checkup.
I didn't need a checkup. All I needed was a good night's sleep. It'd been so long that the idea of sleep was more appealing than sex. How sad is that?
As I turned to grab the stapler, Ryder mopped the water from his face with his shirt-sleeve.
"Matthew Ryder," Jacob said, showing no embarrassment over exposing our family's—my family's—dirty laundry to a co-worker. "I didn't recognize you under all that blood."
"Hey there, Voorsanger. Minor cooking accident. The kitchen is in worse shape than I am."
"Heard you're taking Harrison's place on Sex Crimes. You up for it?" His voice held a challenge.
I glanced from one man to the other, wondering if there was a reason why Ryder might not be ready to take over Mitch Harrison's case load. Particularly the string of sadistic sexual assaults that had plagued the city the past few months. All tied to one assailant using a street drug nicknamed Death Head to subdue his victims. Harrison had been frustrated as hell by the case, chased down every lead, but at the time he'd spun out on that bridge two weeks ago, he'd gotten nowhere.
Ryder didn't answer Jacob right away. Instead, he held his gaze steady, meeting Jacob's dead-on. "Yeah. I'm up for it. Soon as the doc puts my scalp back together, that is."
Taking my cue, I wielded the surgical stapler, breaking up their touching reunion. "Jacob, I'm sure they're waiting for you back at the bar." My Uncle Jimmy's bar hosted all our family holidays. "And you," I pivoted Ryder back into place and planted a firm hand on his head, "hold still."
The sharp clack of the stapler firing snapped through the room, making them both jerk.
"I'll figure out something to tell your mother." Jacob spoke as if granting me a royal boon. "Call me when you're done here." He left, the curtain rattling shut. I was surprised the blood hadn't scared him off earlier. Like I said. Stubborn.
Then he poked his face through the curtain again. Beckoning me to come closer. I leaned toward him.
"You sure you're okay?" His low baritone was for my ears only, as was the concern on his face.
"Go. Have fun with my crazy family. I'm fine."
He gazed into my eyes, effortlessly read the lie there, and brushed my hip with his palm, an open invitation. "Right. Just checking. Call me."
Then he was gone again. I turned back to the job at hand, ignoring Ryder's amused look.
"So you and Voorsanger…" Ryder said as I finished stapling his laceration.
"Were married. Once. A long time ago." It wasn't a secret. "You do know I'm medical director of the Advocacy Center?"
"Actually, you never introduced yourself."
I covered my chagrin by hastily clearing away the suture tray. Had I really not introduced myself? I snapped my gloves off and turned back to him. My chest and neck flushed with embarrassment. I'm not used to tripping up over little things like simple manners. It's usually bigger things that get to me. Like my fight with the HMO that had deteriorated into a shouting match and still left Mrs. Kowacz stranded in my ER instead of in hospice care where she belonged. "I apologize, Detective."
He pushed out of the chair and turned to me with a full-wattage smile. "No problem. Let's start over. I'm Matthew Ryder."
I took his outstretched hand and shook it. His hand was large enough to swallow mine whole, but he didn't squeeze too hard. Instead, it was a brief, firm contact. "Angela Rossi."
"Nice to meet you, Angela Rossi. If what Voorsanger said was true," he jerked his head at the curtain Jacob had disappeared through, "and your shift is over, then how about joining me for dinner?"
I hesitated. Something I hardly ever do. Usually I'm the first to leap into a situation, trusting my instincts and my ability to tap-dance my way out of problems. But even I know better than to date patients or co-workers. Ryder fell under both categories. Still, something in me wanted to take him up on his offer. And I hesitated.
Hesitation is never a good thing in the ER. Moments of doubt are when patients die. Things happen at lightning speed during those moments, things you can never take back again.
Before I could answer Ryder, the curtain was thrown aside, and two security guards rushed in, carrying a woman's body between them. "She was dumped out of a car, bleeding everywhere," one said breathlessly as they heaved her onto the gurney. "Christ, doc, do something!"
Ryder jumped back, startled. I slammed the code alarm and reached for the woman's head, checking her airway while controlling her C-spine. She was pale, her complexion almost matching the gray hair matted to her scalp. "Hand me that oxygen mask."
He placed the non-rebreather mask onto the woman's face as I wrenched her shirt open, exposing two gunshot wounds to her chest. A nurse jogged in to see what was going on, took one look, and shouted for someone to call a trauma code. She grabbed the monitor leads while I jammed a 14-gauge angiocath into the woman's arm and hooked it up to a bag of saline, no pump or anything, just let it pour in.
"Sats are dropping," Shari, the nurse, said once the pulse ox was hooked up.
"Bag her. Heart sounds are muffled. I have to needle her."
Before I could try to drain the blood collecting around her heart, the monitors alarmed. "No pulse!"
"Chest compressions." Damn it. This woman needed to be in an OR. Now. Instead, she was on a bed in a suture room with no surgeon in sight.
"Ryder, hand me that bundle, the one labeled vascular." He spun around and rummaged through the shelf behind him, finally reaching the sterile vascular set.
"What are you going to do?" He handed me the instrument tray.
I wrenched the sterile sheets open, exposing an array of clamps, sutures, needle drivers, scissors, and a scalpel. "I'm cracking her chest."
Shari's hands stuttered in their rhythm and I saw the question in her eyes, but she knew we had no choice. She scooped up a bottle of Betadine and flooded the left side of the woman's chest with the brown surgical soap as I snapped on a pair of sterile gloves. Ryder took over chest compressions without being told.
"Damn it, where is everyone?" I asked, holding the knife poised for a skin incision. I really, really didn't want to do this: It was a last-ditch effort, doomed to failure, but the woman was already dead. It wasn't like I could make her any deader.
"That MVA coded up in the ICU. They were rushing him back to the OR," Shari answered.
"Hold compressions." Ryder eased back, his face dripping sweat onto my semi-sterile field. Least of my worries—or my patient's. I sliced through my patient's flesh. I had to put some muscle into it, pushing my way through the tough connective tissue that held the rib cage together.
"Pull that apart and hold it." I used Shari as a rib spreader. Sliding my hand between the ribs, I pushed the spongy lung tissue aside.
I held my patient's heart in my hand. It felt boggy, like a half-filled water balloon. Pericardial tamponade. Fluid built up around her heart, strangling it so it couldn't beat. From the amount of blood, there was probably a major vessel torn as well. One thing at a time. First, I clamped the aorta.
Next, I needed to release the tamponade. Cutting a simple flap in the membrane covering the heart would do the trick.
Except for one thing. I knew what I had to do. In fact, I could see the steps of the operation to create the pericardial flap and then repair any holes in her heart or blood vessels. I could see it all like a dizzying complex series of textbook pages flipping through my vision in 3-D Technicolor.
But I could not move. My body was locked into place, rigid, unresponsive to my brain's frantic commands.
"I know her," Ryder was saying. His voice sounded normal, as if there were nothing wrong. "It's Sister Patrice. She works over at St. Timothy's."
"She's a nun?" Shari said.
In my head I was cursing. Screaming. This woman was dying under my hands, but Ryder and Shari were too distracted to notice I was frozen, unable to move or function. Panic surged through me. Had I gone crazy? Was this really happening? How could they not see me standing here like a zombie, my patient dying right in front of me?
Then I realized it wasn't only my voice I heard. There was music. Gorgeous, angelic chords so crystal clear they made my heart ache. Women singing. Ave Maria. The notes swirled around me, lifting me up beyond my body. Soaring and dizzy, I was looking down on the scene below me. Yet at the same time, I was tethered to the earth, totally paralyzed.
Panic and disorientation flooded me even as the music seeped into every cell of my body, bringing a sense of harmony and peace. The paradoxes tugged at my senses, leaving me reeling.
Then everything stopped, the world as frozen as I was.
I forgive you.
Who said that? It was a woman's voice, each word sparking golden notes shining bright and perfumed with honey, but I couldn't move or respond.
Help the girl. Save the girl.
The voice dropped to an urgent whisper, becoming bruised indigo blows against my flesh, strained with pain, copper-heavy with blood. A dying gasp—inside my head.
This was no time for a detour into The Twilight Zone. I was this woman's last chance. Her only chance.
Anger sliced through my panic. Rage, fury, whatever it was, it burned hot. A fire raging inside me, out of control. My vision blurred, I couldn't blink, couldn't focus, couldn't speak. Hell, the things I couldn't do were infinite. Starting with saving my patient.
A shudder roiled through my body, and suddenly, I could move again. My hand spasmed, squeezing the woman's heart, but no one knew except me. In fact, Ryder and Shari didn't seem to have noticed that anything was wrong.
But I knew. Something was terribly wrong.
Shoving my fears and questions aside, I grabbed the scissors and sliced a window in the pericardium. I milked a blood clot out, did internal compressions, waiting for the heart to fill and start to beat on its own.
It never did.