A Grain of Truth

by Christian Unge

Genres: Medical Thrillers

Synopsis

Stressed-out, sleep-deprived and pill-popping Dr Tekla Berg is as unusual a central character as you will find" Irish Independent

"Tekla is a terrific character" Literary Review

"Tekla Berg is a brilliant character" Susi Holliday

"A memorable protagonist" Imran Mahmood

"Tekla is a scapel-sharp character" Jens Lapidus


A woman is found wandering the corridors of Nobel Hospital in Stockholm, accompanied by a young boy. She appears to be looking for a man who was involved in a car accident earlier that day.

Meanwhile, in one of the emergency rooms, Tekla Berg is fighting to save a patient who was seriously injured in the same incident. The resulting chaos goes beyond anything anyone could have predicted, leaving hospital staff, police and everyone else involved equally shocked and perplexed.

Hospital Director Monica Carlsson has stepped up her attempts to privatise her fiefdom with the launch of an exclusive patient hotel, a controversial liver transplant unit and the prestigious recruitment of star surgeon Klas Nyström. It soon becomes obvious that Klas has his own agenda and is working to undermine Tekla at every turn.

But Tekla is too distracted to meet this challenge head on: she has become obsessed with the mystery surrounding the woman and her young charge - for the boy's identity remains unknown and no trace of his past can be found.

Reviews for Hell and High Water

"A gripping crime novel . . . fast-moving and packed with convincing detail and memorable characters" Literary Review

"As gripping as it could be . . . An authentic and seriously exciting debut" Irish Independent

Translated from the Swedish by George Goulding and Sarah de Senarclens

Release date: July 7, 2022

Publisher: Quercus Publishing

Print pages: 432

Sample

The young mother with the pram finally managed to extract her cheese sandwich and the woman swiftly took her place. She knew what she wanted and how much it cost. Two ten-kronor coins in the slot. Then a glance at the chairs over by the reception.

For one second, when time seemed to stretch out, tearing apart her very being, she went into free fall, struggling to get air into her lungs. Her chest tightened.

“I’m hungry.”

Spinning around just as the jingle of the second ten-kronor coin died away deep in the bowels of the vending machine, she felt the boy’s warm, dry hand in hers.

“Where . . .?”

The boy looked worried.

“What? What’s the matter, Mamma?”

“Nothing.”

She breathed out, closed her eyes, pretended to rub one to remove something, inhaled deeply and opened them wide again. Felt an urge to crouch down and hug the boy, as if to make sure that he was real, that he had not just appeared in a dream. She resisted the impulse. Her neck was sore and, when she filled her lungs, a weight settled across her chest. Something was broken, she knew that, but it was too late to try and fix it, nothing could ever be mended again.

“Wait, darling.” She keyed in the right number and the machine responded with a thud. She reached in and removed the cold bottle, which felt slippery against her sweaty palm. “Here.” Her mouth was parched all the way down to her vocal chords. She coughed up some phlegm and swallowed it.

The boy took the bottle. Did not seem to notice her shaking hands. He walked slowly back to the red plastic chair. The woman followed him.

“Why do we have to be here? There’s a horrible smell.”

“We . . .” She faltered, looked at the boy’s lined boots, at the laces that had been dragged through the slush. There were grey mud stains on his navy blue trousers, and the light red down jacket had been mended in a few places. “You’d better take off the mask so you don’t scare anyone.”

“But . . . Iron Man’s one of the good guys, Mamma.”

“I know. But please just listen and do as I say.”

Reluctantly, the boy pulled off the gold mask and held it firmly against his body.

“Come here,” she said and leaned forward. She drew him towards her. He stood still, peering into a cubicle where a patient was lying on a bed and breathing into a mask. A monitor above the patient’s head was beeping.

The woman felt cold. A piercing cold. She had to get her pulse down, try to seem normal. Surely a hospital ought to feel more secure than this, isn’t that the basic premise? What can have gone so badly wrong, even here? She removed her jacket and wrapped it around the boy.

“No,” he insisted.

“Aren’t you cold?”

“No.”

He shook off the jacket almost in a panic, as if it were on fire.

“Sure?”

“Yes.” The boy sounded annoyed. “Don’t do that.”

“O.K. Sorry darling. I just don’t want you to be cold.”

“I’m not cold.”

“O.K., O.K.” The woman took back her jacket and began to walk. The boy followed her, his boots squeaking against the plastic floor. The sound jarred her. She was shaking so badly that the pain shot all the way down to the base of her spine.

They made their way along the corridor, weaving in and out among nurses who were darting back and forth between cubicles and opening and shutting doors. She liked the way there seemed to be order in this chaos, like a big factory where everyone has a set job to do.

The woman searched her way systematically through the ward. She wanted to avoid asking questions, attracting attention. That much she had learned. It is what he always said: “Whatever you do, keep a low profile.” If only she could rewind the tape, start all over again.

In one room, a nurse was putting a plaster cast on a young man. In another, a family was sitting next to a woman whose eyes were red from crying. Her make-up had run down her cheeks.

Eventually, the woman realised it was pointless. She was drifting about in a world she did not understand. She walked up to the desk, had to make an effort to separate her tongue from the roof of her mouth. Coughed. A blond woman looked up from her computer and straight into her eyes.

“May I ask if you’ve admitted any people who were injured in a car accident?”

The nurse nodded. “Are you family?”

“Yes.”

“They’re very busy at the moment. I don’t think you should go in right now.” The nurse pointed to a door marked Emergency Room 1. Then she added: “The older man is having a C.T. scan, then he’ll be taken to K 81.”

“Is he going to make it?” The woman cast a worried glance towards the emergency room.

“Who?”

The woman pointed to the door. When she saw how badly her hand was shaking, she quickly brought it down again. The nurse looked puzzled, turned her head and seemed uncertain as to how much she could say. Relatives must never be left without hope, yet at the same time, one should not promise too much. “Don’t know . . . But the older man is in a less serious condition, he’s not intubated.”

The woman said thank you and stepped back before the nurse got a chance to ask her if she herself was alright. She wiped the sweat off her forehead and felt an unpleasant searing pain down her spine.

Oddly enough, she was quite intrigued by all the symptoms affecting her body. They were new to her. Apart from the terrible period pains she had always suffered from, she considered herself healthy. But now that something different was manifesting itself every minute, like the numbness in the fingertips of her left hand, she could not help stopping, noting and being fascinated.

“What’s a ward?” the boy asked.

The woman reflected. “A corridor with lots of rooms. A bit like a hotel. Or like . . . Princess Leia’s starship.”

The boy’s eyes widened. “Are there toothbrushes in plastic packages?”

“Maybe.”

“And chocolate?”

The woman felt a rush of warmth when she heard the boy pronounce the “ch” in chocolate, as if he were clearing his throat. As if he had a mouth full of soft, warm chocolate.

“Don’t think so. Are you still hungry?”

He nodded.

“Come.”

They left A. & E. and set off up the stairs. She tried to remember what the nurse had said: K 81. All in good time. She had to get it right. Mustn’t leave any unfinished business when they then disappeared for good.

They stopped when they reached the entrance level. The ceiling was low. She felt trapped, almost a sense of panic. The floor was wet and covered in grit. The boy looked over at the Pressbyrån newsagent a few metres away.

“Can we buy something?” he asked.

“Absolutely. Sure we can.”

They made their way past stationary prams, drab processions of bulky winter coats and two women in white who were slowly pushing a transparent box on a steel frame with wheels. Their shuffling steps bore witness to many sleepless days and nights on the front line. She thought she detected a whiff of acrid sweat.

The sweet, warm scent of cinnamon buns inside the newsagent’s made her feel sick. She felt a pressing discomfort in the left side of her groin. “What would you like?” the woman said.

The boy looked around. “I want food.”

“Food?” the woman asked before remembering that he had not touched the lunch they had been given at the house. He had only picked at the potatoes. The woman went to the back of the shop where they had a variety of ready meals. “Lasagne?”

The boy shook his head and made a face.

“Beef and rice?”

The boy considered her question. Then nodded slowly. They took the box of food, paid and left the shop. On the way out, the woman noticed that the smell of sweat was actually coming from her. It was sour and rank. She hadn’t had time to wash with soap that morning, only splashed some water onto her armpits. If she thought hard enough, she probably knew why she stank. And yet she couldn’t quite remember. Only feel the nausea. Over what she had done. Her stomach hurt. She needed a toilet. Her body was drained. Her head pounded, thoughts bouncing about between the hard cranial bones.

She needed to stop for a few moments and make an effort to work out where she was. Her clothes felt heavy, as if they were drenched in something. She imagined it to be petrol. She looked at the boy, who was walking along holding the box with his meal. The woman became confused, thought she was seeing two faces in one. Foreboding dulled the sense of security that had come from having the boy with her, a feeling that she was all by herself. Then another stab of pain hit her in the stomach. She had to hold her breath for a few seconds, try and think away the pain.

“I wonder what he’s doing now,” the boy said. He was dragging his feet, the grit scratching the floor. Why was the boy thinking of him now? Why couldn’t he just be content to be with her? After all the time they had spent together. It wasn’t fair. She felt a violent rage that she struggled to contain.

“Don’t know. What do you think?”

The boy shuffled on.

“What?” he said.

“Nothing.”

“You’re weird, Mamma.”

“Am I? How do you mean?”

“You say funny things.”

“What sort of things?”

“Don’t know. You’re just weird.”

“Wait here,” she said, she couldn’t hold it back any longer. She dashed into a toilet. Maybe she should have taken the boy in with her, but it was too late now. Even as she sat down, the contents of her bowels emptied into the toilet bowl with force. She flushed, washed her hands and pushed the door open. Coming out she found herself staring straight into the Iron Man mask.

“Well done for staying.”

They walked on, reached some stairs, paused and stood aside for two people dressed in blue. The boy kept staring at the floor.

“What’s the matter, darling?”

“Nothing.”

“Go on, tell me.” And then in a lower, gentler voice: “Tell me.”

The boy turned towards her and flipped up the face of the mask. He responded to the quieter tone.

“Well, you’re saying kind of strange things.”

“Am I saying things you don’t understand?”

“Yes. And you’re talking to yourself.”

“Don’t be silly.”

“Yes you are.”

The boy looked uncomfortable. She doubled over as another piercing pain shot through her stomach, but she breathed through the spasm, which left her with a lingering feeling of nausea. Her field of vision suddenly shook, like when a pitching boat hits a wave and then settles back onto a steady course. She thought she understood what was going on, but there was no alternative. She had to hurry up, do what had to be done.

The boy folded down his mask again. And said, his voice echoing inside it:

“Come on Mamma.”

“Right, boss,” she said. “Let’s eat now before we die.”

“International Men’s Day.”

“International Wednesday?” Tekla asked.

Viola smiled and held open the door to the emergency room. “International Men’s Day.”

Tekla went in, put on a plastic apron, a face shield and double plastic gloves, then slipped her ID card into the computer. “Didn’t even know there was such a thing as Men’s Day.”

“It doesn’t work,” Lisa, the head trauma nurse, proclaimed drily. She was by her standing desk, where she had a laptop, a blank patient file and a can of Diet Coke. Tekla punched in her code for the third time.

“They’re replacing it with some sort of device that’s meant to recognise fingerprints,” Lisa added, taking a sip of Coke.

Tekla looked at the gruff nurse: dyed blue hair in a rough plait, rolled-up sleeves and broad shoulders.

“Fingerprints?” Tekla said. “Why not voice activation while they’re at it?”

“They’re making the same idiotic mistakes here as on the other side of town,” Lisa said and went over to pull the string that opened the double doors separating the emergency room from the ambulance bay. One of the doors got stuck halfway but Lisa simply gave it a thump, as if it were a punching bag at the gym. “They think fancy technology can do our job. They’ve forgotten that human beings aren’t cars. The last time those idiots engaged their brains, it was all about lean business models, wasn’t it? And what became of those millions? They could make a start by fixing that door.”

The nurses Viola and Johan went out to meet the ambulance staff. Tekla thought about the text she had received the previous day, which she had still not answered, but relegated it indefinitely to the back of her mind.

“How am I supposed to access the patient file then?” she asked.

“Not possible right now,” Lisa said, throwing up her hands in despair.

“Maybe a good thing.” Tekla fished a can out of her pocket.

“You should perhaps complain to your immediate superior.”

Tekla considered it briefly, but that only reminded her how exasperating her new boss was. “Thanks, I don’t think so. Let’s focus on the patient for once.”

She finished her drink in five gulps while walking towards the ambulance crew.

“Hit and run in Stuvsta,” the male paramedic said.

Tekla raised a hand. “Just a second. Is his airway clear?” She turned to the woman on the team who was holding an Ambu bag over the battered face, but she couldn’t see much because of the neck brace and all the straps stabilising the patient. Two feet covered in blood stuck out at the bottom of the stretcher.

“Yes,” the woman said. “But he needs oxygen.”

“O.K.,” Tekla said, turning her attention back to the ambulance crew, while Johan and Viola together transferred the patient to the hospital’s own stretcher. “Carry on.”

“He’s probably around forty, identity unknown. We found no wallet or any other clue as to who he might be. We just got a category one call for a car accident at the bus shelter in Stuvsta, near the commuter train station. This one and an older man.”

Looking over the shoulder of the paramedic, Tekla could see another ambulance pulling into the bay.

“Ragna is standing by in Emergency Room 2,” Lisa said.

“Is that really a good idea?” Tekla was worried, but at the same time she felt oddly confident. Ragna Sigurdsdottir could look after herself. It was Ragna’s pregnancy that she was concerned about. The anaesthetists appeared behind Tekla, a woman and a man. They put away their kick scooters and donned plastic clothing and face shields in silence.

“When we got to the scene, the patient was lying on his side. Lowered consciousness but revivable. G.C.S. five. A passing jogger who had reported the accident was waiting at the scene. Free airway but traumatic injury to the face. Bleeding from the head and mouth. Saturation 90 during transport with 10 litres oxygen through a mask. Blood pressure around 80. Increased heart rate between 100 and 120. Nasty lower left leg fracture which we’ve immobilised.” The ambulance man looked up from his tablet. “That’s all, I think. Except that he’s had a total of twenty milligrammes of morphine.”

“Why weren’t they taken to the N.S.K. trauma centre?”

“They already had a case. You can’t expect a hospital that cost fifty billion to deal with two trauma patients at the same time. Are you out of your mind?” the paramedic said with a smile.

A quick look at the stretcher told Tekla that everything was being done properly. The head stabilised. The anaesthetic team had the airway under control. “What about the other man?” Tekla asked.

“His condition is far less severe. A fractured forearm and a blow to the head, but he’s responding.”

“Thanks,” Tekla said, pulling down her face shield. She approached the patient. It was clear he was badly injured. Hit by some driver who fled the scene. Maybe drunk or stoned. A senseless act if ever there was one.

“And we don’t have a name?” she called out to the ambulance crew who were moving towards the exit.

“Sadly not. And there was no-one around who knew who he was.”

“What about the driver?” Tekla called out.

“A white car, a station wagon, which drove off. The police arrived at the same time as us.”

“Let’s hope they catch the bastard and lock him up for good.”

Tekla began at the top. The man’s blond scalp had been torn away on the left side so that the bone beneath shone like dirty marble under the strip lights. The left half of his face seemed to have been pushed in and looked rubbery. When Tekla carefully palpated the cheekbone, it gave way and the globe of the eye sank in. Nasty fractures which would require the skills of many specialist surgeons.

“This is going to be tough.” A film about reconstructive plastic surgery at the Mayo Clinic played in Tekla’s mind.

The man was in deep sedation from the morphine, and unresponsive. Probably about forty, normal height with unusually long muscles across his right upper arm. Tekla grasped his right hand, which felt somehow rough, as if he earned his living doing physical work. All of which matched the outdoor clothing he wore and his suntan, which was unusual for the time of year. Tekla cast her mind back to her childhood in Edsåsdalen. She used to love picking up logs and balancing them on the chopping-block. With a cigarette in the corner of his mouth, her father would swing the axe up into the bright blue sky and, at the last moment, say: “Now keep your paws out of the way or there’ll be bangers for supper”. Tekla would quickly pull her hands back and watch the log split in two. She remembered the sound of the axe sinking into the block. How they then laughed, working away until the basket was full of firewood and the ground strewn with cigarette butts. She missed that comforting silence when darkness slowly crept in from the woods.

“Saturation 88,” Viola said and upped the oxygen.

The anaesthetist and her nurse were talking nearby: “. . . need to intubate . . .” and “. . . is going to crash . . .”

“Do you need any help?” Tekla asked.

The name of the anaesthetist was Helena Gray, a 31-year-old registrar who carried herself straight as a ramrod and still had half her specialist training ahead of her.

“Uncalled for,” Gray said. “What about you? Might be a good idea to call in the cavalry before the patient snuffs it.”

Tekla ignored her and carried on with her examination. A gurgling sound came from the patient’s airway. “Do we have a blood pressure reading?”

Nurse Anki was just releasing the cuff, which let out a hiss followed by a scratching sound when she tore off the tourniquet. “60 over unmeasurable.”

Tekla felt the patient’s wrist: no pulse. She applied two fingers to his groin. A very faint, quick pulsation. “Have we got a cannula?”

“It’s not working,” Johan said. He was kneeling beside Tekla, looking for veins in the man’s brown forearms. It was pointless, there was no blood in the vessels, they had collapsed. Tekla noted that the suntan only went as far as the man’s upper arm.

“Hand me the intraosseous drill, please,” Tekla said, turning to Lisa. “I think we need the on-call surgeons,” she added, and she thought she detected a smirk on Gray’s face just as the anaesthetist was holding up the laryngoscope to intubate the patient.

“Which category is that?” Lisa asked, picking up a telephone. She went over and ran her finger down a laminated list hanging on the wall. “And, most importantly, what colour and number do I call?”

“Oh Jesus!” Tekla exclaimed. “Just get the switchboard.”

“They probably also have a colour and a number,” Lisa said drily.

“Tell them you need the on-call surgeon over here.”

Anki began to cut open the man’s trousers with some large scissors. “Tell that to the management team, my dear. Their orders are that we stick to the new guidelines right until the end of the trial period.”

“Do you think it’s category one, red?” Lisa said. “Regenerative Medicine? Isn’t it supposed to be called Surgery? Or am I meant to search within a unit? There’s a red unit too.”

“Just call the switchboard,” Tekla hissed. She noted that there was less noise coming from the left lung. The right one sounded normal.

Anki went through the pockets of the bloodstained rags. She held up a small piece of paper for Tekla to see. “Can I chuck it away?”

“Go ahead,” Tekla said, glancing at the receipt from Tempo – a food shop – and went on palpating the liver and the spleen. When she applied pressure to the left abdomen, the patient moved one leg.

“Ketamine ready,” Rikard, the anaesthetic nurse said.

“We still don’t have a working line,” Johan said in a surprisingly calm tone. He tapped the patient’s hand, changed the position of the tourniquet and then moved down to the feet in his continued search for a useable vein.

“Let’s see who gets there first,” Tekla said.

“I bet you it’s me,” Johan replied, looking up.

“Intraosseous drill,” Lisa said. “And Klas Nyström is on his way.”

“Oh dear,” Gray exclaimed behind Tekla’s back.

Tekla was startled. “Is he the person on call?”

“That’s what the switchboard told me,” Lisa said, holding the receiver at arm’s length, as if it suddenly smelled bad. “And it was red unit.”

“This could get really exciting,” Rikard muttered, writing something with a felt-tip pen on the syringe he was holding.

Tekla saw that the stethoscope in her hand had started to shake. “O.K. Didn’t know he’d already started.” She wanted a bomb from her Lypsyl tube, but now was not the right time. She felt the patient’s bare belly. Anki had managed to remove both the trousers and the checked shirt, thus revealing the extent of the man’s injuries along his left side. It looked as if the car had driven over him lengthwise. Dark patches of blood, gravel and gaping wounds ran down his abdomen to the lower part of his leg, which was broken in two, with the bone protruding through the skin. It almost looked as if someone had stuck a ski pole into it – actually pushed it in. The skin was a map of dark purple islands, the subcutaneous haematomas. “We may have to call in an orthopaedist as well.”

“What colour would that be?” Lisa asked without a trace of irony.

“Don’t think Klas Nyström needs an orthopaedist,” Gray said.

Tekla ignored the comment and picked up the intraosseous drill. She drove a needle into the patient’s right lower leg. He hardly budged. “We have a line.”

“I’ll do the Ketamine, then,” Rikard said and got a nod from Gray.

The door opened and Tekla relaxed for a second when her quick glance revealed the grumpy but familiar face of Piotr Nowak, also an anaesthetist.

“Has he been intubated?” Nowak asked, walking over to the head of the bed. He kept his hands behind his back.

“We’ve only just got a cannula in,” Gray said. “Do you want me to have a go?”

Piotr nodded.

“50 over unmeasurable,” Viola said after measuring the blood pressure once more.

“Giving Ketamine,” Rikard said.

At the very moment Gray was unfolding her gleaming laryngoscope to find her way through the pool of blood and phlegm into the patient’s windpipe, the doors to the emergency room were flung open and Nyström stepped in.

They moved along a glass walkway. Every now and then a gap between the buildings gave a view onto the courtyards below. Most of those they passed in the corridor were dressed in either white or blue. Doctors, nurses, assistant nurses on their way to the changing rooms after yet another day’s work. The others wore ordinary clothes, just like them. Occasionally they would pass a child and each time she noticed how that caught the boy’s attention. Often it was some older child and there was longing in his eyes, a craving. He had been isolated for so long. He yearned for a real life, to play, to laugh. The woman tried to distract him by pointing out boring busts in the corridor. She was unable to bring them to life. They remained statues. Surrounded by walls that were cracked after years of general indifference. How was it possible to work in such an uninspiring environment without going mad? The urge was back. She needed a toilet again. There was a burning in the roof of her mouth and her tongue was throbbing. She needed something to drink, could just about swallow an ocean.

They stopped in the next lift lobby. She read the signs: the names of the different departments, some of which she partly understood. Haematology was to do with blood. And Endocrinology with hormones. But did that include kidneys? Then right at the top: K 81 – Orthopaedics.

The lift pinged. A monotonous and metallic female voice announced which floor they were on.

“Where are we going?” the boy said.

“We’re going to visit someone.”

She reached for the boy’s hand but it was busy playing with the lift buttons. “Fo-ur, f-ive, s-ix . . .”

“There.” The woman was seeing double but her finger managed to locate the real thing and she pointed to the button for the eighth floor.

The boy pressed it.

For a few seconds in the silence of the lift it dawned on her: she knew where she was. Was she predestined to end up here? Had she gone wrong somewhere? She felt that the decisions she had made at every stage of her life had been carefully considered. But did her perception correspond to reality? Wasn’t the fact of them being there, after all that had happened, the very essence of a failure?

“Eighth floor,” the robotic female voice said. The lift stopped; after a few seconds the doors slid open. Together they read the sign: K 81. This was it. So much was at stake. Maybe failure could be transformed into something else, something with a slightly more forgiving tone.

There was a sour smell when they entered the ward – of something like excrement. It offended the nose. The woman nearly retched. She hoped the boy hadn’t noticed the stench. By the door to the first room there was some hand sanitiser on the wall. The woman hesitated. Would she be told off if she helped herself? She pressed the bottle quickly twice and rubbed her hands hard. Then waved them vigorously in front of her. She felt a stab of pain in the stomach. She would soon need the toilet again. And the nausea refused to go away.

“Why are you doing that?” the boy said.

“I’m disinfecting my hands. It kills the bacteria.”

“Do I have to do it too?”

“You haven’t touched anything.”

“I held your hand.”

She smiled, trying to tell if the boy was doing alright. He hadn’t complained. “That’s true. But you . . .”

“Can I help you?” a woman asked, emerging from a larger room with a number of patients sitting around different circular and rectangular tables. Two men in wheelchairs were watching a huge flat screen T.V. with the volume turned right up, so that the applause of the studio audience and the jovial banter of the programme host could be heard.

“We’re waiting for a patient. A relative.” The woman wondered what had made her say that. It was not like her to improvise. But then nothing resembled anything any longer, nothing would ever be the way it used to be. And now, just as they were entering the ward, there was no turning back, no way out, it was too late.

“Good afternoon, everyone.” The voice was as soft as silk. “How’s it all going here?”

Tekla loosened the tourniquet on the patient’s left thigh and stole a look at the hospital’s new star surgeon. She noted that the fabled Klas Nyström was nothing like what she had imagined. The tales she had heard had blown him up into a larger than life figure. Even her colleague Tarik Moussawi had spoken in hushed tones in the break room when he told them how Nyström had sacked a registrar on the spot in the operating theatre because they had been too slow handing him the forceps. Professor Nyström was also responsible for the annual conference on organ transplantation in Brussels, and the only person with his own parking spot, right by the entrance. The most hotly debated topic, though, was how Monica Carlsson had managed to lure him to the Nobel Hospital. No doubt with large sums of money and plenty of perks.

Nyström was a man of normal build, around fifty with thick, fair hair parted at the side, an enquiring look and a smile more suited to a parents’ evening than an acute trauma response.

Tekla felt warm liquid on her glove, looked down and saw the blood pulsating.

“Oops,” Nyström said, placing himself by the patient’s feet and making a pleading gesture with his hands. “Suggest we try not to waste those little red blood corpuscles.”

Ashamed, Tekla tightened the tourniquet. “Sorry.”

“Is he alive?” Nyström asked.

“So far, he is,” Tekla said.

“But not much longer if you carry on like that.”

“I beg your pardon?”

Nyström leaned forward and looked at Tekla’s badge. She caught a whiff of soap. “Tekla Berg.”

Tekla went to get the ultrasound machine but could feel the surgeon’s light blue eyes on her neck.

“Emergency doctor, right?”

“Yes, why?”

“Excellent. Excellent. You know, in the new organisation that Monica and I have put together, expertise will descend from the top, in the shape of yours truly in other words, in precisely the same way as here and now, and take over from the generalists once they’ve done their bit. Imagine a spaceship with advanced technology suddenly landing among stone age people.”

Tekla switched on the machine, picked up the probe and performed an overall ultrasound to see if there was any free fluid in the lungs or abdomen.

“Haemothorax in the left lung and free fl