Hell and High Water

by Christian Unge

Genres: Medical Thrillers

Synopsis

The first in a new Swedish crime series featuring Tekla Berg, a fearless doctor with a remarkable photographic memory

"A taut and blistering thriller with the most memorable protagonist ever. Christian Unge is in total control of his environment. It deserves to be huge" Imran Mahmood, author of You Don't Know Me

"Watch your blood pressure! A tense and clever thriller" Lilja Sigurðardóttir

With 85% per cent burns to his body and a 115% risk of dying, it's a miracle the patient
is still alive.

He only made it this far thanks to Tekla Berg, an emergency physician whose unorthodox methods and photographic memory are often the difference between life and death.

Convinced that the fire was a terrorist attack - and that the patient was involved - the police are determined to question him. Almost as determined as those who would silence him at any cost. And while Tekla battles to keep him breathing, she can't shake the thought that something about him is strangely familiar . . .

Tekla has always hidden her remarkable mind from her hospital colleagues, resorting to amphetamines to take the edge off the endless whirl of lucid memories. But now she'll need to call on all her wits as she's drawn into a mystery involving corrupt police, the godfather of the Uzbek mafia, and her beloved but wayward brother.

Translated from the Swedish by George Goulding & Sarah de Senarclens

Release date: June 10, 2021

Publisher: Quercus Publishing

Print pages: 432

Sample

Thursday evening, 6.vi

“Unstable knife injury in Room 1,” Emil said through the partly open door. “23-year-old male. Five minutes.”

Tekla spun around on her stool and met the nurse’s tense look.

“Have you tried to get hold of the anaesthetists?”

“They’re on their way.”

The headache hit her, an ugly little blast striking between the frontal lobes.

Tekla put down the scalpel, peeled off her plastic gloves. She told the patient he could get dressed.

“Have you finished?” the man said in surprise.

“Your anal abscess needs to be debrided again so I’ll fix a follow-up appointment for you in Outpatients.”

“Can you say that in plain Swedish?”

“The pimple in your rectum’s going to have to be squeezed again.”

The man avoided Tekla’s eyes as he struggled to his feet. His body language told her that his masculinity had taken a knock.

Tekla stepped out and set off at a trot towards the triage rooms. Her sweaty palms stuck to the stethoscope, which she was pulling out of her pocket. Her pulse was rising, she knew what stressed her the most, and it was not the incoming patient with the knife wounds.

She went into Room 1.

Cassandra, an efficient assistant nurse with white, cropped hair and a spider’s web tattoo on her temples, turned to face her.

“Apparently he’s lost a lot of blood.”

Tekla saw that Cassandra was waiting for something and she knew immediately what it was. She weighed her different options as she put on a plastic apron and fresh gloves.

“O.K., try to get hold of the consultant on call.”

“What about Hampus?”

Flash Hampus, who had been doing his best to out-manoeuvre her ever since their first night shift together a year earlier.

“Waste of time.”

Anki, a second nurse, pulled up the emergency trolley and opened the medicine refrigerator. Menthol-blue light flooded out and immediately the room felt a little cooler.

“Is there anything I should be getting ready?” she said.

“Some morphine might be a good idea.”

Silence. Tekla stretched.

“Ten milligrammes of morphine, please.”

The headache made Tekla feel sick. She picked up the tube of Lypsyl lip balm, made sure her back was to the room, unscrewed the top and tipped out a little ball of paper, smaller than a frozen pea, which she popped into her mouth and swallowed with some water. Seconds later it kicked in. She shivered all the way down to the base of her spine. Each time, the taste of bitter almonds was just as nauseating. Tekla put away the Lypsyl tube.

A minute or so later, her chief source of trouble came in through the swing doors. Tariq Moussawi, the consultant, ambled over, almost gliding across the floor. He had thick dark hair streaked with grey. The stubble lay like a jet-black shag rug over his face. He said nothing, just stood there with his hands behind his back, waiting for Tekla to get her visor on. Her plastic apron flapped around her.

“Come on,” Moussawi drawled, and gestured for her to spin around. Reluctantly, she did as she was told. Felt the man’s warm, moist breath on her neck, smelling faintly of garlic. Suppressed the urge to retch.

Moussawi tied her apron and took a step back.

“What is it?” he asked brusquely.

Tekla avoided his eyes, afraid to reveal how stressful she found the situation.

“Nothing.”

“I mean the patient,” Moussawi elaborated.

“Oh. A man with knife injuries in haemorrhagic shock.”

Moussawi gave a barely perceptible nod.

“I thought I might need some help,” she said.

“I don’t think so.”

Tekla was unsure what the Baghdadi consultant meant by that. Presumably that he was now in charge, that knife wounds were only for experienced surgeons. And preferably men, because women could not take the pressure in A. & E. Perhaps adding something about all the operations he had performed during the war, with nothing but a penknife and head torch.

“Give me a shout when you’ve reached your limit,” he went on.

So he was just going to stand there and gawp, and hope that she would make a mistake so he could tell Göran and the others how useless she was.

“What?”

“You start, and we’ll see how it goes.”

This was how Moussawi worked. You swam or you sank. Not unusual among senior male doctors. She just had to suck it up. Grit her teeth. Ignore him. Tekla wanted to ask him to leave the room, but she was interrupted by Emil.

“Another alert.”

“Another one?”

“A three-year-old with seizures.”

A gnawing pain in the pit of her stomach. The only reassuring thing right now was the kind look in Emil’s eyes and she clung to that for a second. And tried to put the gorilla beside the E.C.G. machine out of her mind.

“When?”

“Now! We’ll take it in number two.”

Emil pushed open the sliding doors between the two rooms.

Tekla turned and saw the ambulance roll in, presumably with the small child.

She had no choice, so she turned to Moussawi:

“Can you . . . ?”

He held out his empty hands and shrugged.

“I’m not here.”

“O.K. In that case we’ll have to get Hampus,” she said to Cassandra, making little effort to hide the aggression in her voice. She was not going to waste any time thinking about Moussawi’s unorthodox teaching methods. He would step in, but only if it became absolutely necessary.

On shaky legs, Tekla walked into the second emergency room, feeling like a fledgling ejected from its nest that had landed under the nose of a hungry fox.

A paramedic was standing by the trolley, applying three fingers to the tiny child’s soft ribcage to carry out chest compressions. An A. & E. nurse was ushering in the panic-stricken parents. A beep came from the oxygen monitor, which was getting a weak signal from the patient’s earlobe.

The father, all testosterone and sparse stubble, was shouting:

“Do something! He’s dying!”

Tekla could see that the C.P.R. was working and the tube was in the right place. The child’s fingers felt cold and lifeless. Mustard-yellow shit was seeping out of his shorts.

“What’s his name?” Tekla said calmly.

“Oscar,” the mother said, hurrying over. “He . . . he has Gaucher disease type 2, serious neurological damage since birth. Just so you know.”

She sobbed out the words between her tears, looking as if she might faint at any moment.

“Sit down,” Tekla said, pointing to a chair. A nurse came over to help, but the mother waved her away.

The father pointed straight at Tekla.

“Save him, you!”

The mother pulled down his arm and wrapped herself around him.

Tekla let her eyes travel from the concentrated look on the faces of the ambulance staff, past the bloodshot eyes of the parents to a yellow wall chart in the corner of the room. For four long seconds she could see before her Gupta’s Textbook of Paediatrics, page 1364, right-hand column.

“Wake up!” the father yelled. “What the hell are you up to, do something!”

Tekla looked away from the wall and ran her hands over the little boy. His whole body was twitching. Carefully, she pulled back his eyelids and saw that the pupils barely reacted to the light.

“How long have you been at it?”

“Twenty-five minutes,” came the grim reply from the paramedic behind her back.

A nurse was squatting beside them, trying to insert a second cannula into the boy’s wrist.

Anki’s voice could be heard from the other room:

“Knife injury incoming!”

Tekla felt the boy’s stomach and found the scar from the operation. She turned to the mother.

“The spleen’s been removed, right?”

The mother gave a surprised nod. “Why do you ask?”

“And he’s been having a lot of seizures recently?”

“For some months. We must have been here twenty times.”

A lucid moment seemed to hit the father and he clutched desperately at his wife.

“But you’re not to give up.” He stared at the doctor’s name badge. “Do you hear that . . . Tekla Berg! Or I’ll bloody well—”

“Tekla!” Anki called again from the other room. In the ambulance bay, the sound of the sirens bringing in the next patient was dying away.

“I’ll be back,” Tekla said. An assistant nurse led the parents away. And to the rest of the team:

“Keep the compressions going. And we need one more needle. Pull out all the stops.”

Tekla went back to the first room.

The anaesthetist with the Polish name and a lackadaisical look on his wax-like face was known in-house to be a man of few words. Tekla brought him up to date.

“I’ll do the airway. You deal with the rest,” he said.

Tekla wondered if he was joking, but heard no more. He brought out his tubes and his intubation gear, and filled syringes with white liquids. A nurse in a blue cap worked alongside him, as if they were preparing a routine anaesthesia for surgery. Out of the corner of her eye, Tekla saw that Moussawi was still there, loitering by the aluminium cupboards. He was following her every step.

The doors slid open. She walked up to the ambulance personnel, a man and a woman. The blonde woman reported:

“23-year-old man with a knife injury in his left flank. We got to the scene outside the restaurant only about a minute after it happened. He’s lost a lot of blood and is in shock. Blood pressure 80 over 40. Pulse 120. We applied a compression bandage, but it’s slipped down with all the bleeding. We’ve put a large-bore cannula in his right arm.”

Tekla thanked them. The emaciated ambulance man handed her a wallet.

She glanced at the driving licence. The name sounded Finnish. Twenty-three years old.

The fair-haired patient on the trolley had a crew cut and tattoos on his upper arms that crept from under his dark T-shirt. He was gasping and grimacing with pain.

“Can you open up wide?” Tekla said.

The man was exhausted, but he slowly opened his mouth, and Tekla could see that his airway was free. Breathing rapid and shallow. Ice-cold fingers. The monitor showed ninety-two per cent oxygen saturation. The anaesthetist applied a mask and increased the oxygen flow. Tekla listened to the lungs. No breath sounds on the left side.

Tekla suddenly had tunnel vision. In her mind, she was being pitched between the two emergency rooms. Tried to focus on the young man in front of her. Was this the result of some settling of scores between gangs? Or a robbery? A crime of passion or a drunken brawl? She saw before her images from the garage down by the river in Östersund, near her home of Edsåsdalen. An eternity ago. Memories revolving around different kinds of substance abuse. Around Simon. Around their father. Another life, yet fragments that would remain forever in her mind.

The patient groaned with pain. His abdomen was tight. Other than a mass of tattoos and some old scars covering a forearm, his skin was intact. She loosened the bandages and saw the wound: a horizontal gash, about two centimetres wide, a perfect hit between the sixth and seventh ribs in the left thorax. The knife had perforated the lung, and the pleural space was now filled with blood, reducing his oxygen saturation. He had probably lost between one and two litres of blood. A delicate situation, he could crash at any moment.

But there was something that did not make sense. The injury was high up in the ribcage, not in the abdomen. So why was his belly so tight? Tekla tried to leaf through Moore’s Trauma, but was aware she had missed a few lectures in just that course. She also remembered why: her brother’s first overdose. She opened her mouth to ask Moussawi for help, but something held her back.

Agitated voices could now be heard from Room 2. Tekla hurried there and sat down next to the mother. The father was pacing up and down, talking animatedly into his mobile.

“What’s your name?” Tekla said.

“Sophia.”

“Hi, Sophia. Have you discussed resuscitation?”

The mother nodded and looked into Tekla’s eyes.

“We’ve signed something to say we don’t want him put on a ventilator. But Janne’s . . . he hasn’t accepted it. He’s always working . . . he’s a firefighter, many weekends and nights. And Oscar’s been sick for so long . . . we can’t take . . .” She shut her eyes and covered her face. Then she gripped Tekla by the shoulder and whispered:

“Don’t let him suffer.”

A thought flashed through Tekla’s mind, about that one second when everything comes to a standstill, when decisions are taken: Paul Tibbets flying Enola Gay over Hiroshima, did he hesitate?

“Get me ten milligrammes of Stesolid,” Tekla said to the nurse, who gave her a questioning look. “Give him five.”

“But . . .”

“I’ll do it myself. And fetch some Claforan. We won’t bother with cultures, just do the antibiotics quickly.”

The nurse brought the syringe and the medicine. Tekla lifted the cap of the little catheter on the back of the boy’s hand and injected five milligrammes of Stesolid.

She returned to the patient with the knife injury and said to her emergency team: “We have to roll him onto his side.”

Then she saw: another bleeding wound, further down the flank, in his lower back.

“So, two injuries,” she said aloud. “One in the thorax and one above his left kidney. We need to get him to surgery.”

“Fifty over unmeasurable,” the anaesthetist said, holding the oxygen mask to the patient’s face. Two men rushed into the room, closely followed by a night nurse who was doing her best to keep them out.

“You two, you are not allowed in here . . .”

The men ignored the nurse.

Tekla had time to register that they were wearing leather waistcoats with the same badges. White T-shirts. One of the men was in chocolate-coloured leather trousers, the other in stone-washed jeans. Both were bulky, like old weightlifters whose muscles have turned to fat. Arms and necks covered in tattoos. A shaved head and fluffy goatee on the first, and a bleached crew cut on the second. They took up position at the foot of the trolley. Tekla glimpsed a pistol in the waistband of one of the men.

“Will he make it?” the slightly taller one asked in a strong Finnish accent.

Tekla saw the terrified nurse behind them go to the telephone and pick up the receiver. The shorter man turned to her and shook his head. The nurse put down the receiver and backed away. Stared at the pistol in his hand.

“He’s lost a lot of blood and needs to go for surgery.”

The larger of the intruders came close to Tekla and put a hand on her shoulder. She could feel his rings against her collarbone and tried to ignore the pistol just within sight.

“We’re counting on you –” he looked at her name badge – “. . . Tekla Berg.” Then he stepped back and stood beside his companion.

The father barged his way in from the other emergency room and shouted:

“He’s not breathing!”

Tekla turned, picked up a syringe from the anaesthesia trolley. She held it by her side as she walked over to him.

“Oscar is terribly sick, you know that. Gaucher type 2 is incurable. And you’ve decided that you don’t want him to suffer. But this may be blood poisoning, so we’re giving him antibiotics. I had to sedate him heavily, but I don’t have time to explain any more now.”

“He’s not bloody well breathing!” The eyes of the firefighter father looked as if they were about to pop out of their sockets, he was so angry.

Tekla leaned towards him.

“And now you need to calm down so we can get on with our job.”

She drove the syringe into his muscular thigh and squeezed out all of the liquid.

He shouted in pain, but he had no idea where it was coming from. His hands reached for Tekla’s throat, but one of the bikers pushed him away and shoved the drugged father back into the other room. He stumbled and the last Tekla saw was that he had collapsed onto a chair.

Tekla turned to Moussawi, and the scene seemed to freeze. She knew there and then that he had seen it all. She was in deep trouble.

Thursday evening, 6.vi

“Can’t get a blood pressure reading,” the anaesthetist shouted.

The room swayed around her. Tekla felt sick and registered that sweat was trickling down her spine. She was on the point of leaving the room or telling Moussawi to take over when she heard the voice of Emil, like a circus ringmaster’s, coming from the doors:

“Hampus is on his way!”

Tekla took a deep breath, closed her eyes and took herself back to her native Jämtland. To the rowing boat by the small lake. To Simon and her father, waiting for her to pour coffee from a steaming thermos flask. Saffron-yellow autumn colours on the carpet of leaves by the water’s edge. Simon telling her to be careful with her piano fingers. Tekla saying: “You’re welcome to play the piano yourself, you idiot. I can hold my drumsticks with my feet if I have to.” Pappa smiling, a cigarette in the corner of his mouth. “Quiet now, so we get a bite before it’s late and Mamma goes to sleep.” As if their mother ever bothered to stay up for their sake, Tekla thought.

Bang! Anki slammed the door of the medicine cabinet.

Tekla opened her eyes. Took three quick steps over to the stabbed gang member.

“Get me a drain. Largest you have.”

She tilted the bed, foot-end up.

“I’m intubating,” she heard the anaesthetist say, somewhere in the background. His voice sounded distant and metallic.

The bikers were following the drama with grim expressions. Keeping a tight hold on their pistols. Tekla heard one of them speaking on his mobile.

Just as she was pulling on her sterile gloves, Hampus Nordensköld came into the room with another nurse. His hair was all over the place.

“What’s going on here?”

Tekla had never seen him on such a high.

The shorter of the bikers, with the shaved scalp, held up his arm and stopped Nordensköld from getting to the patient.

“One doctor’s enough. She’s got the situation under control.”

“Excuse me . . .”

Tekla was amused to see the anger bubbling up in Nordensköld’s face.

“You can go into the other room,” she said. “A boy with Gaucher who has sepsis. Find a place for him in the I.C.U. and get his dad a bunk.” Tekla looked over Nordensköld’s shoulder and saw the father sitting, propped against the uncomprehending mother’s shoulder. “He’ll be asleep for at least four hours.”

As if Nordensköld had the faintest clue about Gaucher disease, Tekla thought. But like all male doctors, he would rather tell a barefaced lie than admit his ignorance.

Nordensköld pushed his fingers through his unruly mop of hair and lumbered through to Room 2 in a huff.

“Scalpel,” Tekla said, once the wound was clean.

“No pulse,” the anaesthesia nurse called out, a note of desperation in her voice.

“Cardiac arrest,” the Polish anaesthetist noted, his tone laconic.

Tekla was just about to say “compressions, please” when the taller biker took three steps forward and started C.P.R. In the right rhythm and with the right pressure, perfectly executed.

“Keep going, doctor,” he rasped.

She took the scalpel from Cassandra and made an incision along one of his left ribs. She then used her index finger to dig a canal over the rib and in towards the chest cavity. Suddenly, fresh blood came pouring out over the patient’s flank and down onto the pale-grey linoleum floor.

“Blood,” she said, as if anyone could possibly have missed the deep red fountain spurting from his side.

The doors to the room opened again and the lead nurse came in.

“Some more bikers are here, outside.”

The two in the room looked at each other in surprise. Tekla felt as if she were in the middle of an episode of the T.V. series Sons of Anarchy.

“You take over,” the beefiest of the bikers grunted. Cassandra put down the dressings she was holding and heaved herself up onto the trolley to continue pumping. The shorter man felt behind his back and drew out his pistol. Pointed it in the direction of the doors.

Four other men came in, and the first bikers relaxed. The same gang. They talked animatedly, and Tekla picked up something about Albanians and rats.

She was standing with her finger inside the warm chest cavity and could feel faint pulsations from the heart massage. She was trying to focus, even though sweat was running into her eyes and stinging like vinegar.

“Drain.”

The noise level was rising.

She took the thick plastic tube from Anki and pushed it in with a rotating movement. Fresh blood flowed out into a bag, which Anki just had time to connect.

“Is there any O neg on the way?” she called to the lead nurse, who was standing rooted to the spot by one of the walls.

“I’ve got it here.”

“Hook it up under pressure.”

Tekla looked over her shoulder. Moussawi was still in the same place. Arms folded. His face wore a different expression from before.

After another minute or so she heard the anaesthetist say to Cassandra:

“Pause for a while.”

For a few seconds the room was deathly quiet. The gang members waited.

“Weak pulse,” the anaesthetist said.

Tekla closed her eyes for a second. She saw Simon’s cheerful toothy grin and his cheeky eyes before her.

The sound of metal on wood and rubber squeaking could now be heard from the entrance to A. & E. The S.W.A.T. team marched in, all three with weapons drawn.

*

Tekla could just see the policemen throw the bikers onto the floor and handcuff them. She tried to concentrate on sewing the thick drain into place in the patient’s ribcage, finally managing to secure it with a few rough stitches. One of the policemen – two metres tall and preposterously broad-shouldered – came up to Tekla and pulled down the lower half of his balaclava. There was a camera attached to the top of his helmet. He stopped by the monitor, which was showing a cardiac rhythm of 120 beats per minute.

“All good, doctor?”

At first Tekla was startled to see the large automatic weapon around his neck, but his sympathetic look calmed her. She tried to smile.

“He’ll make it, I think.”

“Good work. Any minute now you’ll be rid of these jerks and be able to get back to normal.”

An assistant nurse came in from the corridor, pushed past the policemen and shouted:

“We’re in major incident mode! Söder Tower’s exploded.”

Tekla dropped the forceps and needleholder onto the sterile blue cloth and saw how the policemen first started talking into their radios and then with each other. The atmosphere at once became charged. She heard the words “explosion” and “fire”.

The tall policeman came up to her again.

“There’s been a blast in Söder Tower, followed by a blaze. Our team’s been called there.”

“You won’t be leaving us the gang members, I hope?” Tekla said, as she taped a large dressing over the drain. The anaesthetist hooked up another blood bag, the pressure was now a stable 80 over 60.

“The regular police patrol will have to take them to the station on Torkel Knutssonsgata.”

“Tekla!” Cassandra shouted from the far side of the chaos. “The incident commander wants to talk to you.” She held up a telephone.

Tekla checked with the anaesthetist that the patient was under control, then removed her blood-covered gloves and plastic apron.

“He’s stable. We’ll swing by X-ray on our way to the I.C.U.” In the other room, the little boy was about to be taken to the paediatric intensive care unit by another anaesthesia team.

Tekla took the telephone and introduced herself.

“I’ve been instructed to tell you that you’re to lead our first medical team at the fire,” incident commander Leif Törblom said, in what sounded to Tekla like a slurred voice. “We’re busy setting up a team of core staff, but we need to get more doctors out to the scene quickly.”

Tekla looked around. She had no choice but to do what the incident commander said: put on her rescue jacket and make her way to Söder Tower. She left the emergency room, stopped by a washbasin and quickly swallowed a bomb, which she washed down with lukewarm water. In the ambulance hall she met Johan and Jessica, who had been assigned as nurses to the first response team.

“We’re off then,” Tekla said. She saw the policeman from the S.W.A.T. team turn and fix his blue eyes on hers before he climbed into a silver-coloured van and disappeared in the direction of the fire. She had a funny feeling about it. Who had “instructed” Törblom that Tekla, and no-one else, was to head up the first response team?

Thursday evening, 6.vi

“Is he dead?” Johan said.

“Don’t know.”

“He must be, no?”

“Can’t you just wait!” Tekla snapped. “How am I supposed to take his pulse with all this going on?”

She knew she ought to apologise to Johan for losing her temper, but after all the patients she had taken care of she was beginning to feel that she had had enough. Her fingers were still resting against the throat of the injured man and she let her eyes stray for a few seconds’ respite. The flames had already reached halfway up the tower where the building was being renovated. The smoke rose like a black pillar against the sheer pink veil of the evening sky. She would remember every detail; that was her blessing and her curse. Tekla shivered at the cold air brushing the back of her neck, while the heat from the fire vibrated two hundred metres away. There was a smell of burnt plastic and scorched skin. Every now and then the rumble from the fire was drowned out by exploding panes of glass and the sirens of the emergency vehicles.

“Where did you find him?” she said. She gave up trying to find a pulse.

“Outside the switchroom. Under a spiral staircase.”

Tekla got to her feet and looked at the firefighter. Only now did she see how sooty and sweaty he was.

“Sit down and take a rest,” she said.

The firefighter sank onto a roll of hoses, opened his jacket and wiped his hand over his dirty face. His head fell forwards, as if the vertebrae in his neck had given way. Tekla saw how his whole body began to shake. She knew she should be going up to him and putting a hand on his shoulder, but instead she stayed where she was and stretched her aching back. For the first time in more than two hours she let her shoulders drop a few centimetres.

“Was he the last one you got out?”

He nodded.

Tekla looked over at the inferno. The last of her patients would be the first to die. The body wouldn’t be easy to identify. She stuck her hand into one of the pockets of the rescue jacket and brought out a black triage card to mark him as dead, the plastic reflecting the flames.

“How many have you taken care of?” the firefighter said.

Tekla did not even have to think. She could describe each and every one of the casualties: colour of clothes, hair type, facial expression, body temperature. Down to the smallest detail. Everything, except their smell.

“This one makes twelve,” she said.

“They should have stayed put. Not run out into the stairwell.”

“You’d never have been able to get up to eighty metres with those ladders anyway.”

The firefighter shut his eyes, trying to shield himself from the truth.

“How many dead?” he said.

“Only one, so far. But several of the worst injured may not survive.”

Tekla stood there, staring at the scorched body. It was a failure, in so many respects. She turned to face the reassuring darkness over by the Bofills Båge apartment building, got out the tube of Lypsyl, shook yet another little ball into her hand and swallowed it quickly. Did not even notice the bitter taste. It would take effect after a minute or so.

Somebody squatted down next to her.

“Hardly looks like a human being,” he said. It was Johan.

“More like a charred animal carcass on a smoking battlefield,” Tekla muttered, and was about to ask for a bottle of water when she suddenly saw the burnt man’s chest move.

She leaned forward, her knees sinking into the soft earth. She put her ear to the place where there should have been a mouth, but where now there were only large, copper-red blisters covered in soot and blood.

“He’s breathing!”

She took a torch out of her breast pocket and shone it into the eye that was not covered in burnt flesh.

“He has pinpoint pupils. We need to set up an I.V.!”

Johan went to fetch his emergency equipment bag while Tekla examined the crooks of the arms, but the fire had destroyed every visible blood vessel. Face, torso, arms . . . she estimated that eighty per cent of the surface area of his body had third degree burns. The clothes were gone, even his genitals were unrecognisable. She palpated his head with the tips of her fingers and found a spongy recess at the back.

Johan returned in no time.

“It’ll have to be intraosseous,” Tekla said. “Here, there’s a relatively undamaged patch on one of the knees.”

Johan brought out the drill and attached a needle with a yellow top.

“Why didn’t I look for a pulse in his groin in the first place . . .”

Tekla took aim at the bone surface of the right shin, close to the knee, grasped the drill and braced herself. She drilled all the way down to the marrow. Not so much as a shiver of pain from the patient.

She looked the man over. Normal build. Normal height. Impossible to guess how old. No hair left. Face basically gone. The whole head a smoking, bloody lump of meat. The body a black carapace of scab. Pictures of Pompeii came to Tekla’s mind, how people had been buried alive in whatever position they happened to be in. Many appeared to have been asleep when the volcano erupted. How had it felt to be lying there? What would she