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a number sixteen or fourteen needle. Quickly, please.”
    Missing from the emergency, except in himself, was any sense of tension and urgency. Lou wondered if anyone in the room really cared whether John Meacham made it or not. It would not be hard to understand if they didn’t, even though, as Sara had said, it should never be a caregiver’s role to pass judgment on any patient.
    This was as bad as it could get.… Poor bastard.… Poor victims.
    What in the hell happened?
    A large-bore needle with a plastic catheter running through it was brought on an instrument tray, along with latex gloves, a large syringe, surgical sponges, some surgical snaps, and several culture tubes.
    Blood pressure, seventy over thirty. Oxygen saturation, 60 percent. Color worsening.
    Moving rapidly, Lou gloved and swabbed some Betadine antiseptic below Meacham’s collarbone on the right side. Then he set the plastic catheter aside and attached the needle to a 20 cc syringe. His movements were careful and considered, but almost automatic, like a boxer throwing a right-left-right combination.
    To Lou’s left, behind the crowd, he could see the neurosurgeon, Prichap, gazing almost placidly out the glass wall of the cubicle. No apparent concern, no offer to help out.
    The needle thrust was where the right second rib space was intersected by an imaginary line between the middle of the collarbone and the nipple. Gripping the syringe tightly, Lou forced the needle against the top of the third rib, and then drove it to the hilt, over the bone and into Meacham’s chest. The jet of air, under great force, actually blew the plunger out of the syringe. Lou twisted the syringe from the hub of the needle, set it on the tray, slid the catheter into Meacham’s chest, then quickly sutured it to the skin. Air continued to hiss out as the collapsed lung struggled to reexpand.
    Blood pressure, eighty over fifty. Color slightly improved. O 2 sat, seventy-two.
    “Chest tube kit, please,” Lou said firmly.
    “Here you go, Doctor,” Turnbull said, replacing the used steel tray with a fresh one and opening the setup used to insert a much larger tube.
    Lou glanced over and realized that the blown IV had been replaced by one that was running smoothly. The emergency was beginning to feel more normal. Despite some improvement, however, Meacham was still in big trouble. In case he was not in a coma, Lou anesthetized an area of skin over the fifth rib, two inches below the catheter. Then, using a scalpel, he opened a slit through skin and muscle, grasped the end of the chest tube with a heavy clamp, and drove it into the space between the still-deflated lung and the inside of the chest wall. Given the relatively minor trauma of most of the patients in the Eisenhower Memorial Annex, this was, he realized, the first time he had inserted a chest tube since before he was sent away.
    Just like riding a bike.
    A suture to hold the tube in place, connection to a water-seal container to keep air from being sucked back into the chest cavity, and the deal was done.
    Pressure, still eighty over fifty. O 2 sat, seventy-nine. Not good.
    Lou knew that all he had accomplished was bringing John Meacham back to a man with a bullet hole in his head.
    “Nice job,” Turnbull whispered, squeezing Lou’s elbow.
    “Thanks, although I suspect the barn door might be closed shut by now. I don’t know who I should go ballistic at first—the respiratory tech, the IV nurse, or that Prichap guy.”
    “I haven’t had much experience with him, but like I said, I’ve never heard anything bad.”
    “Well, you have now. How about I take a few deep breaths in the interest of reestablishing my serenity, and speak to him.”
    “There’s a small nurses’ lounge out there to the right. Tell me when, and I’ll bring him there for you.”
    “Provided you can get his attention away from the painting on that wall out there.”
    Lou checked Meacham over again. Not much change. He tried to imagine