The River Sorrow

by Craig Holden

Genres: Literary Fiction; Suspense

Synopsis

In one of the most unique and powerfully realized debut novels of the decade, Craig Holden creates a page-turning drama that is both emotionally shattering and harrowingly plausible.

When a fatally burned victim is brought into the Morgantown General Hospital emergency room, a young doctor's life is changed irrevocably. For Dr. Adrian Lancaster, the arrival of "John Doe" is only the first of a bizarre and bloody series of events that will force him to relive his violent past and put him on the run. On the road and underground, accused and accuser, Lancaster's only hope for survival lies in facing the terrifying truth.

Release date: December 24, 2008

Publisher: Delta

Print pages: 416

Sample

ONE
 
Like some mythical dragon a helicopter screams down out of the night, its spotlights illuminating the white cross on the asphalt landing pad and blinding those on the ground. Dr. Adrian Lancaster and three of his team watch from just inside the end of the enclosed walkway leading out from the ER. The huge machine settles toward the earth, brilliant against the blackness of the night sky. Even in the tunnel the noise is deafening and the frigid wind whips their faces and stings their eyes.
 
The chopper, laced in red and blue running lights, stops cold two feet off the ground, then touches down. Heads bowed, the trauma team runs, pushing a stretcher before them.
 
“He’s bottoming!” the flight doctor, Ann Palicki, shouts over the whacking of the blades. She has only one patient, a burn, on this flight, strapped into the lower berth. “Third degree on the face, chest, and full left arm. Respirations ten per minute and dropping.”
 
Normally a case like this would go directly to one of the regional burn centers, in Toledo or Ann Arbor. But with respirations so shallow and slow, and no tracheal tube in place, this one wouldn’t have made it.
 
When Lancaster steps up and inside he can see the damage. The left half of the face is destroyed, a mosaic of bloody exposed muscle, subdermal membrane, and strings of blackened hanging skin. The left eye is covered with a saline-soaked gauze pad. The left ear has burned partially away and the nose and lips are swollen and split from the flames.
 
An obstructed airway is the first enemy. Shock is second.
 
“I tried to intubate but the throat’s swollen,” Ann says. “He managed to keep breathing so I just kept it open as I could and used the ambu bag. I didn’t want to risk cutting him in the air. Bumpy ride tonight.”
 
“What happened?”
 
“His car hit a tree, but it didn’t look too damaged. I don’t know what caused the flames. They were limited to him for the most part. Also, there’s a pretty bad contusion back on the head we’ll have to watch.”
 
Then Lancaster catches a whiff of something, gasoline maybe.
 
“There was no engine fire?” he says.
 
“No.”
 
“Lower body?”
 
“Bloodstains around the left knee.”
 
“No burns?”
 
“No.”
 
“Weird,” he says. He turns to a first-year trauma resident who’s shifting nervously from foot to foot. “We’re going to need a burn team in here. When we get inside, you get on the horn. I have to establish an airway before anything. This one’s a fucking mess.” To Ann he says, “How about an ID?”
 
“No.”
 
“He’s John Doe,” Lancaster announces.
 
Ann and the pilot lift the wooden pallet and feed it down to the resident and the two trauma nurses. Then they hand down the two IV bags and the line in the man’s arm. The team leaves, one pushing the stretcher, one working the ambu bag, one holding the bags up so the fluids will continue to feed into the patient’s veins. Lancaster and Ann follow at a trot.
 
The official time of touchdown was 11:55 P.M., Saturday, January 12, 1991. By midnight only the pilot, an ex–Air Force lieutenant who once flew huge dual-propped Sikorski troop-movers over Vietnam, is left to clean out the bird.
 
Inside, under the halogen arc lamps of the trauma stall, it is all shouting out stats and orders for blood work and chemicals and equipment and X-rays, communication somehow happening in the cacophonous web of raised voices and mechanical noises. Dr. Lancaster swears and throws a hemostat at the tiled wall before he finishes the tracheostomy and gets a tube anchored so the ventilator can take over Doe’s breathing.
 
“Next?” he says to the resident.
 
The resident stares back at him wide-eyed.
 
“It’s a burn,” Lancaster says.
 
“Fluids.”
 
“Good boy. We’ve got a peripheral line in the right arm. Now we’re going to start one subclavian, where we can really pump the juices.”
 
While Lancaster worked on the tracheal tube, others were cutting away what was left of the patient’s charred overcoat and flannel shirt. Except for the pad over his eye and a thin chain and medallion around his neck, he lies exposed from the waist up.
 
Lancaster is surprised to see that the unilateral burning of the face is continued on the body. The left arm and shoulder are damaged even worse than the face, with the tissue below the elbow scorched black. The left upper chest and left abdomen are burned badly too. But the surrounding tissues—the right chest and even the right side of the neck—show little burning at all.
 
“Look at that pattern,” he says. “You’ve got a clear and distinct line.” As he speaks, Lancaster snips the chain and tosses it on the pile of clothing. Then he drives a long latex-coated IV tip into the depression beneath the right clavicle. When he gets blood back, he removes the needle, leaving the latex tubing in place. Quickly, with help from the resident, he attaches the line and tapes it into place while one of the nurses opens the Y-valve connecting the line to bags of normal saline solution and plasma.
 
“Ever see anything like this?”
 
The resident looks up and shakes his head.
 
“Chemical burn,” Lancaster says. “A spill. See it?”
 
The resident looks again. “I see it,” he says. “But that’s not what happened here. There were open flames. Look at the charring. Look at his clothes.” The resident kicks at the pile of blackened cloth at his feet.
 
Lancaster nods in agreement, but something’s not right.
 
With the establishment of the line Doe’s blood pressure gradually stabilizes and starts to come up a little.
 
The first of the burn team is already arriving by chopper.
 
Ann is suturing the head wound.
 
The trauma nurses work with tweezers and sterile water to pick away the destroyed skin. With the fluid and blood-oxygen levels stabilized, the enemies now become infection and damaged tracheal and lung tissue. It will be a hard fight.
 
Since the staff is all busy, Lancaster hands his resident a pair of heavy bandage shears and nods at the legs. “Start with the belt, work down. Take everything off. Keep your eyes open, especially for that left leg.”
 
The resident begins to cut.