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Teague’s heart sounds were muffled and distant. There was tenderness in the center of his sternum—enough tenderness to cause the semi-comatose man to cry out when the spot was pressed. His belly was soft and not the least bit tender. His lungs were clear. Legs, arms, unremarkable. Skull and scalp also normal, except that there were a dozen or more neurofibromas hidden beneath Teague’s long, strawlike, dirty blond hair.
    In short, there was no evidence for bleeding anywhere. So why was Teague in shock?
    The likely answer at the moment centered around trauma to the miner’s breastbone, and beneath it, his heart.
    “Laura, where’s Dr. Crook?” he asked.
    “On his way in. Turns out his beeper was accidentally shut off, and his phone wasn’t working. The Sandersonville police went out to his place and woke him up.”
    Sandersonville was twenty minutes from the hospital and Crook was hardly the sort who would simply jump into a pair of sweats and race on in—especially when there was no definite indication in any of the victims that a cardiologist would be needed.
    “Dr. Rutledge?”
    Lee gestured at the monitor—70/30.
    “Prepare to intubate him, Jon. Anesthesia around?”
    “In the OR.”
    “Radiology?”
    “Same. She’s doing some sort of procedure with Dr. Terry.”
    Inwardly Matt groaned. He had intubated dozens of patients, many of them critical, so that was no problem. But his ability to interpret an ultrasound was average at best. In a life-and-death situation like this one, he would want a radiologist’s opinion.
    “No problem,” he said. “Get me a seven-point-five tube, please. Laura, could we talk out there?”
    The nurse looked at him curiously.
    “Of course,” she said.
    “Jon, just shout if you need me.”
    Matt walked Laura to the nurses’ station. She was a straight-laced grandmother in her early fifties, traditional in her approach to medicine, and a damn fine nurse. She was never comfortable with Matt’s open style, manner, and dress, and she had said so on several occasions. Still, over the years, they had managed to co-exist with few problems. Now, he knew, he was about to put their mutual respect to the test.
    The commotion in the ER seemed to have leveled off, and the moaning from the injured miners was much less.
    “How’s he doing?” Blaine LeBlanc asked as they passed.
    “Later,” Matt said.
    “You talk to me before you do anything heroic, you hear? That . . . that weirdo killed one and maybe two of my men.”
    “Sure, Dr. God,” Matt said. “I’ll be certain to consult with you.”
    He turned his back on LeBlanc and spoke softly to the nurse. From what he could discern, blood was building up between the lining of Teague’s heart and the heart muscle itself. The resultant constriction of the heart muscle was keeping it from filling properly between each beat.
    “Laura, this guy’s got a pericardial tamponade.”
    “How do you know?”
    “That’s what it’s got to be. We need to stick a needle into it and drain the blood.”
    “Can’t we wait for Dr. Crook?”
    “Unless we can be sure he’s going to be here in the next five minutes, the answer is no.”
    “What about some tests? An ultrasound?”
    “Radiology is in the OR. I don’t trust the tech or me to read one with certainty. Besides, I don’t think we have time. This kid is going out.”
    “Maybe that’s for the best,” Laura said.
    “Now, don’t let us get started on that,” Matt said. “Please get me a pericardial drainage kit.”
    “Matt, I don’t like this at all. How many times have you done this procedure?”
    “A few during my residency,” Matt lied. “I can do it.”
    “Pressure’s not reading,” Lee called out. “EKG is showing many extra beats.”
    “Please,” Matt said, heading back to room 10.
    “If you’re ordering it, I’ll be right there with the kit.”
    “Remember what I told you,” LeBlanc said as Matt passed him.
    Matt knelt at the head of Darryl Teague’s