Chapter 3 - The Mark Beneath the Sleeve
Derek’s first abnormal result arrived at 1:26 a.m.
Creatine kinase.
High.
Not catastrophic.
High enough.
Dr. Tessa Monroe stared at the number on the monitor.
“Muscle injury.”
Keane stood beside her.
“Could still be trauma.”
“Combined with this?”
She nodded toward the treatment bay.
“No.”
A second result appeared.
Inflammatory markers elevated.
White blood cell count modestly increased.
Lactate normal.
Renal function acceptable.
Nothing screamed immediate collapse.
Nothing allowed them to relax.
Nadia stood beside Derek’s bed as ultrasound gel spread across his upper arm.
The sonographer moved slowly.
Derek watched the ceiling.
“Any pain?”
“No.”
Nadia raised an eyebrow.
He sighed.
“Five.”
“Progress.”
“I’m learning.”
The ultrasound technician paused over the upper arm.
“What?”
Nadia asked.
The technician did not answer immediately.
She changed the angle.
Pressed slightly.
Derek’s entire body went rigid.
“Still five?” Nadia asked.
He breathed through his nose.
“Seven.”
The technician looked toward Keane.
“There’s fluid.”
“Where?”
“Tracking along the fascial plane.”
Keane moved closer.
“Abscess?”
“Not a clean collection.”
“Gas?”
“I can’t confidently say.”
Tessa looked at Keane.
“CT.”
He nodded.
Derek opened his eyes.
“Am I staying?”
Keane gave him a look.
“You stopped being a discharge candidate the moment that sleeve passed your elbow.”
Derek turned toward Nadia.
“Congratulations.”
“For what?”
“You won.”
The words bothered her.
“This isn’t about winning.”
“I know.”
“Then don’t say it like that.”
Derek considered her.
“Fair.”
Nadia leaned against the counter.
“Why did you hide the upper arm?”
“I didn’t.”
“You rolled the sleeve exactly far enough for us not to see it.”
“That isn’t the same thing.”
“Derek.”
He looked away.
The answer came several seconds later.
“I knew it looked bad.”
“So?”
“If I showed everything, somebody would start asking the questions Keane is asking.”
“That’s what hospitals do.”
“Not all questions are harmless.”
“Neither is whatever is happening to your arm.”
His jaw tightened.
Nadia softened her voice.
“Were you threatened?”
Derek turned back.
“No.”
“Asked to keep quiet?”
No answer.
“Did Northstar tell you not to report the dive?”
“I didn’t say that.”
“You didn’t have to.”
Derek sat motionless.
Nadia had seen stubborn patients.
Men refusing admission because they had work at six.
Mothers refusing tests because nobody else could pick up their children.
Teenagers terrified their parents would find out what they had taken.
This was different.
Derek did not seem afraid for himself.
He seemed to be protecting a structure around him.
People.
Jobs.
Maybe reputations.
“What do you think happens if you talk?” she asked.
“Depends who listens.”
“Tell me.”
He looked toward the hallway.
“You wouldn’t believe me.”
“Forty-five minutes ago a senior attending told me my concern was impossible.”
That earned another faint smile.
“I’m reconsidering impossible things tonight.”
Derek’s expression faded.
“We were at Blackwater Reach for a supervisor certification dive.”
“How many people?”
“Six divers. Four topside crew. One project director.”
“Eli was one of the divers?”
“Yes.”
“What went wrong?”
Derek’s eyes drifted to his injured arm.
“Something below us wasn’t on the map.”
The CT transport team arrived before he could say more.
As they rolled Derek toward imaging, Keane stopped Nadia.
“You stay.”
She looked surprised.
“I’m assigned to him.”
“Tessa can go.”
“Why?”
Keane studied her.
“Because I need to talk to you.”
That sentence created a very specific kind of panic in new nurses.
Nadia immediately reviewed every action she had taken.
Had she overstepped?
Spoken outside scope?
Embarrassed him?
Lorraine noticed her face.
“You’re not being fired,” she muttered.
“That’s reassuring.”
Keane waited until Derek disappeared through the double doors.
Then he leaned against the workstation.
“What made you keep looking?”
Nadia blinked.
“I told you.”
“No. You told me what you found. I’m asking why you didn’t accept the first explanation.”
She considered that.
“My dad used to do that.”
Keane frowned.
“Do what?”
“Underreport pain.”
“Military?”
“Carpenter.”
Keane seemed mildly surprised.
“He crushed two fingers when I was fourteen. Came home, ate dinner, told my mom he’d pinched his hand. She took one look and drove him to the hospital.”
“What happened?”
“Three fractures.”
Keane nodded.
“So Vance reminded you of your father.”
“Not exactly.”
“Then what?”
“My dad had this way of moving when something hurt. He’d rearrange everything around the injury instead of protecting the injury itself.”
Nadia glanced toward imaging.
“Derek did the same thing.”
Keane looked at her for a long moment.
“When we’re busy, pattern recognition keeps people alive.”
She waited.
“But it also gets people hurt.”
There it was.
The lesson.
“You think I anchored.”
“I think both of us did.”
Nadia’s eyes widened slightly.
Keane continued.
“I anchored to timing. Eight days. Stable saturation. Intact neurologic exam. I decided decompression injury didn’t fit, so I treated every new piece of information as evidence for something simpler.”
“You thought contusion.”
“Yes.”
“And I anchored to the dive.”
“Possibly.”
She swallowed.
“So I was wrong?”
“I didn’t say that.”
“You’re very difficult to talk to.”
Lorraine coughed to hide a laugh.
Keane ignored her.
“Good clinicians do not fall in love with being right, Nadia. If the CT shows a deep infection from the puncture and the dive is incidental, you need to be as willing to abandon your theory as I should have been to reconsider mine.”
She nodded.
Then she asked, “Why are you telling me this now?”
“Because you were willing to speak when you thought something didn’t fit.”
His voice remained matter-of-fact.
“Keep that. Just don’t confuse courage with certainty.”
Before Nadia could answer, Tessa called from imaging.
“Keane, you need to see this.”
They moved quickly.
The CT images glowed against a dark screen.
Tessa pointed toward Derek’s upper arm.
“Edema through the muscle compartments.”
Keane leaned closer.
“And that?”
“Possible tiny gas pockets.”
Nadia’s stomach dropped.
“Infection?”
“Could be.”
Tessa moved to another image.
“Foreign material.”
A narrow bright object appeared deep near the posterior upper arm.
Keane stared at it.
“How large?”
“About nine millimeters.”
“The cable?”
“Maybe.”
Nadia said quietly, “He didn’t know something broke off.”
Keane’s face hardened.
“And there’s another problem.”
Tessa changed the image.
The abnormal tissue extended farther toward Derek’s shoulder than any of them had realized.
Not just surface discoloration.
Not just local trauma.
Something was spreading.
Keane took out his phone.
“Get surgery down here.”
Nadia asked, “Hyperbarics?”
“Still coming.”
“Which one first?”
“That depends on whether those gas pockets are decompression related, infectious, or both.”
“Can both happen?”
Keane glanced at her.
“Tonight I’m done calling combinations impossible.”
They returned to Derek.
He was sitting upright again.
Too upright.
People in significant pain often sat rigidly because relaxing meant surrendering control.
Keane pulled the stool close.
“CT found a fragment in the upper arm.”
Derek frowned.
“From the housing?”
“Probably.”
“There are also changes in the deeper tissue.”
“What kind?”
“Inflammation. Fluid. Possibly small gas pockets.”
Derek’s expression finally shifted.
“What does that mean?”
“It means you are not dealing with a bruise.”
“I figured that part out.”
“It means surgery may need to remove the foreign body and inspect the tissue.”
“Tonight?”
“Yes.”
“And the dive?”
“We’re getting a hyperbaric specialist involved.”
Derek looked at Nadia.
Not Keane.
Nadia understood why.
He wanted a translation into human language.
“Are you asking if this is serious?” she said.
“Yes.”
“It is.”
“Am I going to lose the arm?”
The question silenced everyone.
Keane answered first.
“I don’t know.”
Derek’s face did not change.
But Nadia saw his right hand close into a fist.
Keane continued.
“You came in walking. You’re stable. Pulses are present. That matters. But I’m not going to lie to you. We need to move quickly.”
Derek nodded.
“Okay.”
“Now tell me about the cable.”
Derek looked at the ceiling.
For almost ten seconds, nobody spoke.
Then he said, “The cable wasn’t supposed to be there.”
Keane leaned forward.
“What does that mean?”
“It means the training route had been approved because company records showed that section of the seabed was clear.”
“And it wasn’t.”
“No.”
“What was there?”
Derek looked at Nadia.
“A live subsea power-and-data conduit.”
Tessa stared.
“You took trainees around a live cable?”
“We didn’t know.”
“Who did?”
Derek closed his eyes.
“One person did.”
“Who?”
Before he could answer, Derek’s phone vibrated on the bedside table.
All of them looked down.
The screen showed:
ELI MERCER
Derek grabbed it immediately.
“Eli?”
Silence.
His expression changed.
“Eli?”
Nadia stepped closer.
A weak voice crackled through the speaker.
Derek put the call on speaker.
“Where are you?”
A breath.
Then Eli whispered:
“I think something’s wrong with my legs.”
Derek went white.
Keane reached for the phone.
“Eli, this is Dr. Roland Keane at Harbor Crest Medical Center. Can you tell me where you are?”
Another shaky breath.
“Home.”
“Address?”
Eli gave it.
Keane pointed at Lorraine.
She was already calling emergency dispatch.
Keane returned to the phone.
“Do not try to stand. An ambulance is coming.”
Eli’s voice trembled.
“Derek?”
“I’m here.”
“They said it would pass.”
Every person around the bed heard those words.
Derek closed his eyes.
“Who said that?”
But he already knew.
Eli answered anyway.
“Northstar.”
The line went quiet except for his breathing.
And for the first time that night, Nadia understood they were no longer dealing with one patient who had hidden important information.
They might be dealing with an entire group of people who had been told to hide it.
May you like
By 2:00 a.m., a second ambulance was racing toward Harbor Crest—and Derek was finally ready to explain what had happened two hundred twelve feet beneath Blackwater Reach.
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