Chapter 2 - Seventy-Five Seconds
Nadia had imagined confronting a senior physician many times during nursing school.
In those fantasies, she was always calm.
Articulate.
Brilliant.
She cited evidence flawlessly and spoke with such controlled confidence that the room instantly understood she was right.
Reality gave her a dry mouth and a first sentence that fell apart.
“The discoloration—”
She stopped.
Heat rushed into her face.
Keane said nothing.
That was worse than interruption.
“No,” Nadia said. “Let me start again.”
Dr. Tessa Monroe stood a few feet away beside a computer workstation. Lorraine Beckett pretended to reorganize medication labels while listening to every word.
Keane checked the clock.
“Seventy-five seconds.”
“Eight days ago,” Nadia began, “Derek Vance completed an industrial training dive to approximately two hundred twelve feet.”
Keane’s gaze sharpened slightly.
“He told you that?”
“Eventually.”
“He told me he fell during training.”
“He did. He just left out what kind of training.”
Keane’s expression cooled.
“Continue.”
“There was an emergency underwater. Another diver got into trouble. Derek made an accelerated ascent and did not complete his normal decompression profile.”
“How accelerated?”
“He wouldn’t give me the full profile.”
“Then we don’t know.”
“We know it was abnormal.”
“That doesn’t diagnose anything.”
“No. But three days later the discoloration began.”
Nadia could hear the clock ticking despite the noise of the department.
She forced herself to slow down.
“The pattern isn’t centered around his impact point. It tracks irregularly through the forearm. Violet centrally, gray-yellow toward the edges. The skin is warmer and tighter in some areas without the swelling I’d expect from a simple contusion.”
Keane’s eyebrows drew together.
“His pulses are intact.”
“Yes.”
“No significant weakness.”
“There is a small delay when he repeatedly opens and closes the hand.”
“I didn’t see it.”
“Try five repetitions instead of two.”
Tessa looked at Nadia.
Keane did too.
That statement had come out bolder than she intended.
“Anything else?” he asked.
“He rates the pain four out of ten.”
“That’s reassuring.”
“I don’t believe him.”
Lorraine’s head lifted.
Keane’s mouth tightened.
“You’re basing diagnosis on whether you believe a pain score?”
“I’m basing concern on everything he does when he thinks nobody is watching. He rotates his torso to avoid moving his shoulder. He keeps the arm away from his body. He chooses positions where nobody can bump his left side. He can sit perfectly still while talking, but when he stands his breathing changes.”
Keane glanced toward Derek’s curtain.
Nadia saw it.
A crack.
Not agreement.
Attention.
“What exactly are you diagnosing?” he asked.
There it was.
The dangerous question.
Nadia was a nurse.
She could assess.
Escalate.
Advocate.
She was not there to play physician.
“I’m not giving him a final diagnosis.”
Keane’s expression hardened.
“Then what are you asking me to reconsider?”
“I think the dive matters. I think the delayed skin change matters. I think the pain pattern matters. And I think we’re looking at the surface of something we haven’t seen underneath.”
Keane stared at her.
The ambulance radio hissed behind them.
Somewhere down the corridor a child cried.
A monitor alarmed twice before somebody silenced it.
Then Keane spoke.
“That diagnosis is impossible.”
He did not raise his voice.
He did not have to.
“Delayed decompression injury presenting like this after eight days, in a patient sitting upright with normal oxygen saturation and no clear neurologic deficit? No.”
Nadia felt Lorraine shift beside her.
Keane turned toward the discharge paperwork.
Conversation over.
Then a voice came from behind the curtain.
“If she’s right, Doctor, what would you need to see?”
Everything stopped.
Derek Vance stepped into view.
He had put his charcoal shirt back on fully.
Left cuff buttoned.
His face was unreadable.
Keane turned.
“You were listening.”
“Hard not to.”
“You should be resting.”
“I’ve had eight days of people telling me to rest.”
His eyes moved to Nadia.
For one second, she expected anger.
Instead she saw something closer to resignation.
Derek returned his attention to Keane.
“What would make it possible?”
Keane exhaled slowly.
“If this were a significant process related to pressure exposure or deeper tissue injury, I would expect the abnormality not to stop exactly at the place where you decided to stop showing us your arm.”
Derek looked down.
Nadia’s heart accelerated.
She had noticed his reluctance.
She had not understood its scale.
“Mr. Vance,” Keane said, “take off the shirt.”
Derek did not.
Instead he reached for the cuff.
Unbuttoned it.
Rolled the sleeve.
Past his forearm.
Past his elbow.
Past the point where Keane had examined him.
Dark marbling continued upward.
Nadia felt her stomach tighten.
The forearm had not shown an isolated patch.
It had shown the lower edge of something far larger.
Derek rolled the sleeve higher.
Deep violet discoloration spread around most of the upper arm. Two areas beneath the biceps were so dark they appeared almost black under the fluorescent lights.
Gray-yellow branching borders extended toward the shoulder.
The skin looked tight and strangely glossy.
Lorraine whispered, “Oh my God.”
Keane moved before anyone else.
His entire posture changed.
No longer dismissing.
No longer teaching.
No longer standing back.
He stepped close.
“Tessa, gloves.”
She handed them over.
Keane examined the arm without touching at first.
Then gently palpated around the upper edge.
“Pain?”
Derek’s jaw flexed.
“Some.”
“Some?”
“Six.”
Nadia nearly laughed from disbelief.
Keane looked at him sharply.
“You said four.”
“That was before everybody got interested.”
Keane did not smile.
He lifted the sleeve farther.
That was when Nadia saw the puncture.
Barely half an inch.
Narrow.
Closed.
Easy to miss.
The tissue around it was darker than the rest.
Keane pointed.
“How did you get that?”
Derek turned his head.
He looked genuinely surprised.
As though he had forgotten it.
“Cable housing.”
“What cable?”
No answer.
“What cable, Mr. Vance?”
Derek’s gaze moved toward Nadia.
Something changed in his expression.
Not physical pain.
Calculation.
Fear of consequences.
Keane saw it too.
“What happened underwater?”
Derek said quietly, “The training platform snagged.”
“On what?”
“Subsea cable assembly.”
“What kind of cable?”
“Power and communications.”
“And the puncture?”
“Broken housing bracket.”
“Saltwater exposure?”
“Yes.”
“How long was the wound exposed?”
Derek gave him a look that almost seemed apologetic.
“Until I surfaced.”
Keane’s voice became very still.
“How long?”
“Forty-six minutes.”
Tessa swore under her breath.
Nadia stared.
Keane looked at the arm again.
Now the differential diagnosis had widened dramatically.
Pressure injury.
Soft-tissue injury.
Deep infection.
Vascular compromise.
Foreign body.
Possibly more than one process.
“Why didn’t you tell us?” Nadia asked.
Derek’s answer was simple.
“Because I wanted you to look at the arm, not at the company.”
Keane froze.
“What company?”
Derek said nothing.
Keane turned to Tessa.
“Cancel discharge.”
Tessa was already moving.
“CBC, CMP, CK, lactate, inflammatory markers, blood cultures. Add coagulation studies.”
“Imaging?”
“Ultrasound first. Then CT with contrast if renal function allows.”
Nadia asked, “Hyperbaric consult?”
Keane looked at her.
This time there was no annoyance in his face.
“Call them.”
Lorraine stepped forward.
“Roland, chamber team won’t like eight-day delayed presentation.”
“I’m aware.”
Keane returned his attention to Derek.
“Mr. Vance, from this moment forward, you are going to tell me everything.”
Derek gave a quiet, humorless laugh.
“That might be complicated.”
“Your arm is complicated.”
“You don’t understand.”
“Then help me.”
For several seconds Derek said nothing.
Finally, he lowered himself back onto the treatment bed.
Nadia noticed that his control was slipping.
His face had gone paler.
A sheen of sweat formed near his hairline.
She checked his pulse.
Faster.
“Derek?”
“I’m fine.”
“No, you aren’t.”
He looked at her.
“I’m starting to understand that.”
Nadia reached for the blood pressure cuff.
While she wrapped it around his right arm, Keane continued questioning him.
“What company?”
Derek stared at the floor.
“Northstar Underwater Systems.”
Lorraine stopped moving.
Tessa looked up from the computer.
Even Nadia recognized the name.
Northstar was one of the largest subsea infrastructure contractors on the East Coast. They maintained underwater power lines, communications systems, offshore platforms, and municipal tunnels.
Their name appeared in advertisements at airports.
On university engineering buildings.
At Harbor Crest charity galas.
Keane’s face revealed nothing.
“What were you doing for Northstar?”
“Training new dive supervisors.”
“At two hundred twelve feet?”
“It wasn’t supposed to go wrong.”
“What went wrong?”
Derek closed his eyes.
When he opened them again, Nadia saw the answer he had been avoiding since entering the hospital.
“Everything.”
A monitor sounded.
Not Derek’s.
Another bay.
Yet Nadia felt the entire department become strangely quiet.
“What happened to the other diver?” she asked.
Derek looked at her.
“His name is Eli Mercer.”
“You said he walked away.”
“He did.”
“Where is he now?”
Derek swallowed.
“I don’t know.”
Keane stepped closer.
“When did you last speak with him?”
“Three days ago.”
“And?”
“He said he felt fine.”
“That doesn’t answer the question.”
Derek looked toward the rain-dark windows.
“He stopped answering his phone yesterday.”
Nadia and Keane exchanged a look.
The situation had just grown beyond Derek’s arm.
Keane turned to Lorraine.
“Get the hyperbaric physician on the line. Now.”
Then he faced Derek.
“And while we’re waiting, you’re going to tell us what happened at Blackwater Reach.”
Derek’s eyes snapped toward him.
Nadia noticed the reaction.
“So that’s where it happened.”
Derek’s silence confirmed it.
Blackwater Reach.
The name would mean nothing to Nadia until later that night.
By sunrise, she would understand why Derek had tried so hard not to speak it inside Harbor Crest Medical Center.
Because the injury beneath his sleeve was only the first thing Northstar had tried to keep hidden.
May you like
And the moment the first laboratory result came back, Dr. Keane realized Derek might not have eight more days to explain it.
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