Chapter 5 - What the Scan Shouldn’t Have Shown
Eli Mercer entered Harbor Crest at 2:19 a.m. unable to reliably feel his feet.
Within ninety seconds, the department shifted around him.
Dr. Tessa Monroe went with the paramedics.
Keane called the hyperbaric physician again.
Lorraine cleared a treatment bay.
Nadia stayed with Derek because Derek was already trying to leave his bed.
“Absolutely not.”
“I need to know what’s happening.”
“You’ll know.”
“Nadia.”
“No.”
He stared at her.
She stared back.
For the first time, Derek looked mildly offended.
“You’re about five-four.”
“Five-five.”
“You think you can stop me?”
“No. But the security guard behind you is six-six, and he owes me twenty dollars.”
Derek glanced back.
The guard raised one eyebrow.
Derek sat down.
“Smart.”
“I have moments.”
His attempt at humor lasted only until Eli cried out from the next bay.
Derek’s face emptied.
Nadia watched guilt return.
“You saved him once,” she said.
“He wouldn’t need saving now if I’d forced him into a hospital that day.”
“You weren’t his doctor.”
“I was dive supervisor.”
“You were also injured.”
“That doesn’t matter.”
“It does if you’re using yourself as evidence that everybody else should have known better.”
He looked at her.
She continued.
“You didn’t understand what was happening to your own arm. Why do you expect yourself to have perfectly understood his symptoms?”
Derek said nothing.
Nadia had learned something about him during the last two hours.
He did not argue when words hit something he was afraid might be true.
Keane entered.
“We have hyperbarics.”
Derek stood halfway.
“Eli?”
“Stable.”
“Can he move his legs?”
“Some movement. Sensation reduced.”
Derek shut his eyes.
Keane continued.
“His presentation is more compatible with neurologic decompression illness, although the delayed course is unusual.”
“Treatment?”
“Hyperbaric oxygen.”
“When?”
“Immediately.”
“And me?”
Keane’s expression hardened.
“You are the complicated one.”
“That sounds encouraging.”
“Your CT shows a foreign body, deep tissue inflammation, and possible small gas pockets. We cannot assume all of it is decompression-related.”
“Infection.”
“Possibly.”
“Surgery?”
“Dr. Maren Sloan is coming down.”
Derek nodded.
Keane remained.
“There’s another CT finding.”
Nadia noticed his tone.
“What?” she asked.
Keane pulled up an image on the computer.
“Look.”
Nadia stepped closer.
She knew enough anatomy to identify the humerus, surrounding muscle, vascular structures.
Keane pointed.
“See these areas?”
Tiny bright irregularities.
“Yes.”
“Some appear consistent with foreign material or mineral density.”
“From the cable housing?”
“Maybe.”
He switched images.
“But this distribution doesn’t make sense for a single fragment.”
Derek leaned forward.
“What are you saying?”
“We may be seeing multiple tiny particles.”
“Metal?”
“Possibly composite material. Possibly calcification. Radiology is reviewing.”
Nadia looked at the screen.
“What does that mean for treatment?”
“It means surgery may need to explore more than one area.”
Derek asked, “And those darker pockets?”
“Possible gas.”
“From decompression?”
“Maybe.”
“Or bacteria.”
Keane nodded.
“Possibly.”
Derek looked almost amused.
“Comforting list.”
“I’m not here to comfort you with lies.”
“I noticed.”
Keane leaned against the counter.
“What exactly struck you?”
“Broken bracket on the conduit housing.”
“Painted?”
“Coated.”
“With what?”
Derek frowned.
“Marine anti-corrosion coating. Maybe anti-fouling compound.”
“What color?”
“Dark red.”
Keane and Nadia exchanged a look.
“Why?” Derek asked.
“Because if material entered the wound, toxic or inflammatory exposure becomes another variable.”
Derek shook his head.
“That bracket was old.”
“You said the cable looked new.”
“The outer armor looked new. The mounting system didn’t.”
Keane stared at him.
“That’s strange.”
“Yes.”
“How strange?”
Derek hesitated.
“Like somebody had installed new infrastructure on reused support hardware.”
Nadia asked, “Is that normal?”
“No.”
“Illegal?”
“Not necessarily.”
“Unsafe?”
“Depends.”
She waited.
“Derek.”
He sighed.
“Yes. Potentially.”
Dr. Maren Sloan arrived at 2:37.
She was a trauma and acute-care surgeon with silver-framed glasses and the energy of somebody who considered sleep an optional personality trait.
She examined Derek.
Reviewed imaging.
Asked three questions about the puncture.
Then said, “We’re operating.”
Derek blinked.
“That fast?”
“Yes.”
“You don’t want to wait for cultures?”
“No.”
“Hyperbaric treatment?”
Sloan looked at Keane.
“If he needs chamber time for decompression injury, he can still get it. I’m more worried about leaving foreign material inside tissue that appears increasingly inflamed.”
She looked back at Derek.
“You have preserved blood flow and function. I’d like to keep it that way.”
That ended the debate.
Nadia helped prepare him.
As she attached a new IV line, Derek watched her.
“You always argue with doctors?”
“Only on Fridays.”
“What happens other days?”
“I argue with patients.”
“Seems balanced.”
She secured the dressing.
His expression softened.
“Thank you.”
“For what?”
“Not letting it go.”
Nadia paused.
“You don’t know what the outcome is yet.”
“I know what the outcome would’ve been if I drove home.”
Neither of them needed to say it.
Worse.
Possibly far worse.
Across the department, Eli was being transferred toward the hyperbaric unit.
Derek heard the wheels.
“Can I see him?”
Nadia looked toward Sloan.
The surgeon checked the time.
“Thirty seconds.”
They rolled Eli past Derek’s bay.
The two men looked at each other.
Eli seemed smaller beneath the blankets.
Derek stepped close enough to touch the rail.
“I’m sorry.”
Eli frowned.
“For what?”
“I brought you up too fast.”
“You brought me up alive.”
“Eli—”
“No.”
Eli’s voice strengthened.
“You don’t get to rewrite it because you feel guilty.”
Nadia glanced at Keane.
The doctor’s eyes showed recognition.
He had said almost the same thing earlier.
Eli continued.
“Halpern told us not to report it. Occupational health told me numbness could be stress. You didn’t do that.”
Derek swallowed.
“The picture.”
Eli’s hand tightened on the blanket.
“My phone.”
“Where?”
“Paramedic bag.”
“What’s on it?”
“The conduit tag.”
Derek went still.
“What tag?”
Eli stared.
“The maintenance label.”
“What did it say?”
Before Eli could answer, the hyperbaric team started moving again.
“We need to go.”
Eli called back:
“Northstar inspection—six months ago.”
Derek’s face changed.
If the conduit had carried a Northstar inspection label from six months earlier, then the company had known it existed.
There was no mapping discrepancy.
No surprise infrastructure.
No honest mistake.
Someone had knowingly placed a training exercise beside a live conduit and failed to warn the divers.
Sloan touched Derek’s shoulder.
“Operating room.”
He nodded.
As they rolled him toward the elevators, a radiologist hurried toward Keane holding a tablet.
“Roland.”
“What?”
“I reviewed the high-resolution reconstructions.”
“And?”
The radiologist lowered his voice.
“The gas pattern worries me.”
“Infectious?”
“Possibly.”
“What else?”
He turned the screen.
“There’s something tracking along a vessel.”
Keane leaned closer.
His face went still.
Nadia saw it.
“What is it?”
The radiologist answered.
“A small intravascular gas collection.”
Keane stared.
“Eight days later?”
“That’s why I came down.”
Nadia felt cold.
The finding should not have remained there that long if it came from the original dive.
Which meant either their understanding of the timing was wrong—
or something was still generating gas inside Derek’s body.
Keane turned toward the elevator carrying Derek to surgery.
“Call Sloan.”
“She just left.”
“Call her now.”
Nadia asked, “What are you thinking?”
Keane’s answer came quietly.
“That the decompression injury may be real.”
He looked at the scan.
“But it may not be the thing trying to kill him.”
May you like
And upstairs, before the first incision was made, Dr. Sloan discovered that Derek’s small puncture wound had carried something into his arm that no one at Harbor Crest had expected to find.
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