Chapter 6 - The Call From Blackwater Reach
The operating room called the emergency department at 3:11 a.m.
Keane answered.
Nadia watched his face.
It changed.
Not dramatically.
Nothing about Roland Keane changed dramatically.
But his shoulders became rigid.
“How much?”
A pause.
“Send it to pathology and microbiology.”
Another pause.
“Yes.”
He hung up.
“What did they find?” Nadia asked.
Keane looked toward her.
“Material embedded in the muscle.”
“The CT fragment?”
“More than one.”
“What kind?”
“Composite shards. Metal and polymer.”
“From the bracket?”
“Probably.”
“That’s bad?”
“Foreign material can create inflammation. It can introduce bacteria. It can damage tissue mechanically.”
“But?”
Keane exhaled.
“But Sloan says the tissue reaction extends beyond the fragment tracks.”
“So infection.”
“Likely.”
Lorraine approached.
“Eli is in the chamber.”
“Status?”
“Stable. Hyperbaric physician says the neurologic findings support decompression illness.”
Keane rubbed the bridge of his nose.
“So we have two divers from the same event. One with delayed neurologic symptoms. One with deep tissue injury, possible infection, and unusual gas findings.”
Nadia said, “Meaning Derek might have both.”
“Yes.”
Keane looked toward the clock.
“Which is exactly what I dismissed because I wanted one explanation.”
Nadia remembered his warning about anchoring.
He remembered it too.
A phone at the nurses’ station rang.
Lorraine answered.
“Emergency department.”
She listened.
Then frowned.
“One moment.”
She covered the receiver.
“Someone asking about Derek Vance.”
“Family?” Nadia asked.
“No.”
“Who?”
Lorraine’s expression darkened.
“Northstar Underwater Systems.”
Keane held out his hand.
Lorraine gave him the phone.
“This is Dr. Keane.”
A man spoke on the other end.
Nadia could not hear the words.
She watched Keane’s expression flatten.
“No.”
Pause.
“No, you may not speak with the patient while he is under anesthesia.”
Another pause.
“I’m his treating physician. That is the only information you’re receiving.”
Keane listened.
“No.”
Then he hung up.
Lorraine stared.
“Friendly?”
“Extremely.”
“What did they want?”
“Confirmation that Vance was here.”
“Did you give it?”
“No.”
Nadia asked, “Who was it?”
“He identified himself as Grant Halpern.”
The name landed heavily.
“The project director,” Nadia said.
“Yes.”
“How did he know Derek was here?”
Nobody answered.
Derek had not listed Northstar as an emergency contact.
He had not even told registration where the dive happened.
Eli had arrived by ambulance only an hour earlier.
Lorraine looked toward the entrance.
“Could occupational health have called?”
“Possible,” Keane said.
Nadia did not like his tone.
“Possible means you don’t think so.”
Keane glanced at her.
“It means I don’t know.”
His phone rang again.
Different number.
Keane answered.
“Keane.”
The voice was loud enough that Nadia heard fragments.
“…occupational medicine…”
“…continuity…”
“…company protocol…”
Keane interrupted.
“Dr. Penrose?”
Nadia recognized the occupational physician’s name from Derek’s story.
Keane listened.
“Did you evaluate Mercer after the dive?”
Pause.
“Did you know he had chest symptoms underwater?”
Longer pause.
“Did you know they accelerated the ascent?”
Keane’s jaw tightened.
“What advice did you give?”
Another pause.
Then:
“You told him numbness could be stress?”
Lorraine slowly shook her head.
Keane’s voice became colder.
“I want your documentation transmitted to Harbor Crest.”
The response was immediate and apparently negative.
“No. You misunderstand. I’m not requesting Northstar’s internal incident report. I’m requesting the patient’s medical records with appropriate authorization.”
Pause.
“Then we’ll obtain authorization.”
Keane hung up.
“Problem?” Nadia asked.
“Everyone has become very interested in procedure.”
“That usually means nobody wants to discuss substance.”
Keane looked mildly impressed.
“Seven months?”
“Seven months.”
“You learn quickly.”
Before Nadia could answer, a hospital administrator arrived.
Clara Wynn, vice president for clinical operations, wore a coat over clothes that suggested someone had called her out of bed.
“What happened?”
Keane gave her the short version.
Two divers.
Emergency ascent.
Delayed symptoms.
One in hyperbaric treatment.
One in surgery.
Possible corporate suppression of medical concerns.
Clara’s face tightened.
“We need risk management.”
“Already called.”
“Legal.”
“Lorraine did.”
“Public health?”
“Too early.”
“Occupational safety?”
“Not our decision yet.”
Clara looked toward Nadia.
“And she?”
“Nurse Carver identified the inconsistency.”
Nadia felt every eye turn toward her.
“I identified an arm.”
Clara nearly smiled.
“That appears to have been enough.”
The doors from the operating wing opened.
Dr. Sloan approached still wearing her cap.
Nadia’s pulse jumped.
“How is he?”
“Stable.”
“Arm?”
“Viable.”
Derek had not lost it.
Nadia realized only then how worried she had been.
Sloan continued.
“We removed several small fragments. Irrigated extensively. There’s significant inflammatory change but less necrosis than I feared.”
Keane asked, “Cultures?”
“Pending.”
“The gas?”
“No obvious gas-forming destruction where I explored.”
“Then intravascular finding?”
“Could still relate to pressure physiology. Could be artifact. Could be something else.”
Keane nodded.
“Hyperbaric after recovery?”
“I’d support it if chamber team does.”
Sloan looked at Nadia.
“He asked about the nurse before sedation.”
Nadia blinked.
“What?”
“Wanted to make sure someone told you the arm was staying attached.”
Lorraine smiled.
“Charming.”
Sloan walked away.
Nadia turned.
“I’m getting coffee.”
Lorraine said, “You hate coffee.”
“Tonight I’m reconsidering impossible things.”
Keane actually smiled.
Barely.
Nadia had taken three steps when the station phone rang again.
Lorraine looked at the number.
“Unknown.”
She answered.
“Harbor Crest emergency.”
A woman spoke rapidly.
Lorraine’s face changed.
“Slow down.”
Nadia stopped.
“What?”
Lorraine raised one hand.
“Yes, ma’am. Tell me exactly where you are.”
Keane walked over.
Lorraine put the call on speaker.
A frightened woman’s voice filled the station.
“My husband works for Northstar. He was on that dive boat last week.”
Keane leaned toward the phone.
“What’s his name?”
“Marcus Bell.”
Derek had listed Marcus as one of the six divers.
“What symptoms does he have?” Keane asked.
“He says his shoulder hurts. He’s been dizzy. Tonight he started throwing up.”
Nadia felt dread spread through her.
“Any weakness?” Keane asked.
“I don’t know.”
“Any skin changes?”
The woman went silent.
Then:
“Yes.”
Everyone around the station froze.
“What kind?” Nadia asked.
“Purple.”
Keane closed his eyes for half a second.
“Mrs. Bell, call 911 now.”
“He told me not to.”
“Call anyway.”
“Northstar said—”
Keane interrupted.
“I do not care what Northstar said. Your husband needs evaluation.”
The woman began crying.
“I knew something was wrong.”
“You’re doing the right thing.”
After the call ended, Clara Wynn spoke quietly.
“That makes three.”
Keane nodded.
“Potentially.”
Nadia looked at the list Derek had given them.
Six divers.
Three already showing concerning symptoms.
“What about the others?”
Lorraine asked.
Keane looked toward Clara.
“That is now a question bigger than this department.”
Clara took out her phone.
“I’m calling the state.”
At 3:42 a.m., Derek opened his eyes in recovery.
Nadia was there when he became coherent.
His first words were:
“Eli?”
“In hyperbarics.”
“Legs?”
“We don’t know yet.”
“My arm?”
“Still attached.”
He looked at her.
“I asked them to tell you.”
“They did.”
“Good.”
“Derek, another diver may be sick.”
His eyes sharpened.
“Who?”
“Marcus Bell.”
Derek tried to sit up.
Pain stopped him.
“No.”
“Easy.”
“No, no. Marcus was farther from the platform.”
“What does that mean?”
“If Marcus is sick, this isn’t just from the emergency ascent.”
Nadia stared.
“Why?”
“Because Marcus completed his decompression.”
Every piece of the puzzle shifted.
Nadia leaned closer.
“Completed all of it?”
“Yes.”
“You’re sure?”
“I supervised the logs.”
“Then why would he have symptoms?”
Derek’s face went pale for a reason unrelated to surgery.
“Unless the profiles were wrong.”
“What profiles?”
He looked at her.
“The breathing-gas profiles.”
Nadia did not understand.
“Derek.”
He swallowed.
“What if we weren’t breathing what Northstar told us we were breathing?”
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And with that question, the medical mystery became something far more dangerous: the possibility that every diver at Blackwater Reach had entered the water using a plan built on false information.
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