Emily made a faint sound.
Her eyes fluttered.
“Daniel…”
He immediately turned toward her.
“I’m here, sweetheart.”
She looked at him, but there was something uncertain in her expression.
Then her gaze moved to me.
“Please…”
Her voice was barely audible.
I leaned closer.
“Emily, can you tell me what happened to your arm?”
Daniel answered before she could.
“She fell.”
I looked at him.
“I asked Emily.”
His jaw tightened.
Emily swallowed.
“I…”
She closed her eyes.
“It’s okay,” I said gently. “You don’t have to explain everything right now. Just tell me whether the cast was supposed to stay on.”
A long pause followed.
Then Emily whispered, “No.”
Daniel’s face changed.
It wasn’t anger.
It was fear.
Real fear.
Marcus noticed it too.
“Sarah,” he said quietly, “we need to move.”
I nodded.
“Start broad-spectrum antibiotics. Two large-bore IVs. Blood cultures before antibiotics if we can get them without delaying treatment. Labs, lactate, renal function, coagulation panel. Call orthopedics and surgery.”
Marcus moved immediately.
I reached for the cast saw.
Daniel blocked my path.
“You’re making a mistake.”
“Step back.”
“She needs her orthopedic surgeon.”
“Her orthopedic surgeon can examine her after we remove this.”
“You don’t know what’s under there.”
The words hung in the air.
I stared at him.
Neither did he, apparently.
At least, not in the way he wanted me to believe.
“Exactly,” I said. “Which is why we’re removing it.”
The saw started.
The mechanical vibration filled the room.
Emily flinched.
“Easy,” I told her. “We’re almost there.”
The first section opened.
A foul smell immediately filled the room.
Marcus turned his head.
I didn’t.
The skin beneath the cast was swollen and discolored. There were areas of irritation where the fiberglass had pressed into the flesh. Several fingers were badly swollen, and the skin had taken on a dusky color.
But the most important thing was not what I saw.
It was what I didn’t see.
There was no clean surgical dressing.
No evidence of the neat healing expected from a straightforward fracture.
Instead, beneath the cast was a poorly protected wound extending along the forearm.
I felt my stomach tighten.
“Get another set of eyes in here,” I said.
A nurse called for the surgical team.
Daniel took a step backward.
Emily stared at the ceiling.
“Emily,” I said softly, “did you have surgery?”
Her lips trembled.
“Yes.”
“When?”
She didn’t answer.
Daniel did.
“Three weeks ago.”
I looked at him.
“What hospital?”
He hesitated.
“St. Matthew’s.”
“Which surgeon?”
Another hesitation.
“Dr. Robert Vale.”
I knew the name.
I also knew St. Matthew’s orthopedic department.
Something didn’t fit.
“Why isn’t there a surgical dressing?”
Daniel’s expression hardened.
“The cast was changed.”
“When?”
“Last week.”
“By whom?”
“My wife had an appointment.”
“Where?”
He didn’t answer.
Emily whispered, “At home.”
The room went silent.
I looked at her.
“Who changed it?”
She stared at her husband.
Daniel looked away.
“Emily,” I said, “I need you to tell me the truth. Not because anyone is in trouble. Because I need to know what happened so we can treat you correctly.”
Her eyes filled with tears.
“Daniel changed it.”
I looked at him.
“You changed your wife’s cast?”
“He was helping me,” Emily said quickly. “He was trying to help.”
Daniel’s shoulders lowered slightly.
“Her surgeon gave us instructions.”
“Did he?”
“Yes.”
“Written instructions?”
“I don’t have them with me.”
I looked down at Emily’s arm.
There were already too many unanswered questions.
A month-old cast.
A surgical wound.
A home cast change.
A dangerously infected arm.
And a husband who had arrived with an explanation prepared before anyone had examined her.
“Let’s get imaging,” I said.
Daniel shook his head.
“Her surgeon already did imaging.”
“I’m not asking what happened last month. I’m asking what is happening now.”
The nurse returned with the first lab results.
“Sarah.”
I turned.
Her expression told me enough.
“What?”
“White count is very high. Lactate is elevated. Creatinine is up.”
I nodded.
“Start fluids.”
Emily’s blood pressure dropped again.
Daniel sat down.
For the first time since arriving, he looked like a husband rather than a man trying to control a situation.
He took Emily’s hand.
“Please don’t let her die.”
I watched him.
“I don’t intend to.”
His eyes met mine.
“She’s everything I have.”
Emily opened her eyes.
“No,” she whispered.
Daniel looked at her.
She seemed confused.
“No what?”
Emily turned her face toward him.
“You have… the house.”
His expression froze.
I pretended not to notice.
There were more urgent matters.
The surgical team arrived.
Dr. Patel, our orthopedic surgeon on call, examined the arm.
He looked at the cast.
Then at the wound.
Then at me.
“How long?”
“About a month, according to the husband.”
Dr. Patel frowned.
“And the surgery?”
“Three weeks ago.”
“Where?”
“St. Matthew’s.”
He looked at Emily.
“Who operated?”
“Dr. Vale.”
Dr. Patel’s expression became thoughtful.
“That’s strange.”
“What?”
“I don’t remember Vale operating on a case like this.”
Daniel immediately spoke.
“Records can take time to transfer.”
“Of course,” Dr. Patel said.
But he didn’t sound convinced.
He examined Emily’s fingers.
“We need the cast completely off.”
Daniel stood.
“No.”
Dr. Patel looked at him.
“Mr. Harris, your wife may have a serious infection beneath this cast. The longer we wait, the greater the risk.”
Daniel looked toward Emily.
“Emily?”
She closed her eyes.
“Take it off.”
His shoulders dropped.
“Okay.”
The remainder of the cast came away.
The room became very quiet.
Not because what we saw was shocking.
Because it was sad.
This was not an old, healing injury.
The wound looked as though it had never been given the opportunity to heal properly.
There were sutures.
Some had loosened.
The surrounding tissue was inflamed.
There was drainage.
And along the forearm was a faint line of discoloration extending farther than I expected.
Dr. Patel frowned.
“This needs surgery.”
Daniel swallowed.
“What kind?”
“Exploration and cleaning of the wound. Possibly more, depending on what we find.”
“Will she lose her arm?”
Dr. Patel answered carefully.
“We don’t know.”
Daniel closed his eyes.
Emily began to cry.
I moved closer.
“We’re going to do everything we can.”
She looked at me.
“Doctor…”
“Yes?”
“Can I tell you something?”
“Of course.”
She glanced at Daniel.
He was staring at the floor.
“I didn’t fall down the stairs.”
Nobody spoke.
Daniel slowly looked up.
Emily continued.
“I fell in the kitchen.”
I waited.
“It wasn’t a big fall. I slipped. I landed badly.”
“That can still cause a serious fracture,” I said.
She nodded.
“I know.”
“Then why did you tell everyone it was the stairs?”
Her eyes moved toward Daniel.
“Because…”
She stopped.
Daniel stood.
“Emily is confused.”
I turned toward him.
“She’s febrile and critically ill, but she is answering questions appropriately. Let her speak.”
Daniel looked at his wife.
Emily took a shaky breath.
“Because the insurance company asked questions.”
I frowned.
“What questions?”
“About how it happened.”
“And?”
“They said the claim might not cover everything if it was an accident.”