TO SAY THIS WASN’T GOOD was an understatement.

Izzy knelt down in front of Bex. She had managed to get the woman out of her blouse and could see the exit wound of the bullet. It had gone through the right breast and out just above her right shoulder blade. But even with Janine pressing gauze onto the wound, Bex’s bleeding hadn’t slowed.

“We’re going to take good care of you, Miz Bex,” Izzy said, smiling down at her.

The woman’s breathing was labored. “I’m … I …”

“Don’t try to talk,” Dr. Ward said. “We’ll patch you up like new. I can’t risk sullying my reputation as a physician.”

That, at least, brought a smile to the woman’s face. Izzy squeezed her hand.

“Can I … ?” Janine looked up at her. The girl’s hands were covered with Bex’s blood, and quivering with the effort she was making to stanch the flow.

“No,” Izzy said tightly. “You can’t.”

The phone rang again, and they all turned to stare at it. Last time, Izzy had been the one who answered it. The shooter had directed her to do it by jerking the gun in her face.

“Don’t touch it,” he barked.

The phone rang twelve more times; Izzy counted.

Bex’s breathing was tighter, soupy. “Hard,” she said. “To … catch … my …”

Izzy reached for Bex’s wrist, counting heartbeats for her pulse, and doing the math: 240 beats per minute; Bex was tachycardic.

“She probably has a tension pneumothorax,” Dr. Ward said. “We have to get the air out of her chest cavity so she can breathe freely.” He twisted, trying to haul himself upright on his good foot, but he lost his balance and crashed onto his bad leg.

Izzy took the bulk of his weight. “The last thing we need right now is for you to play hero.”

“What we need is a trauma doctor,” he said, meeting her gaze. “And it looks like that’s going to be you.”

Izzy shook her head. “I’m not a doctor.”

“That’s just a bunch of letters after your name. You know what you’re doing, I bet.”

Izzy had seen needle decompressions done before in a hospital setting, when they had sterile conditions and all the proper equipment. She also knew that Bex was not long for this world without some kind of immediate medical intervention. As air entered her pleural space from the wound, the pressure would increase and collapse the lung, which in turn would compress the heart and shift the mediastinum. That meant her heart wouldn’t pump effectively and the vena cava—the big vessel that returned all the blood to the heart—wouldn’t do its job.

Bex started wheezing, fighting for air. Her body shook with the effort. Izzy grabbed Janine’s hand and pressed it down harder on the gunshot wound. Then she stood, summoning all her courage. “This woman needs medical attention,” she told the shooter.

He stared at her.

“Do you want her to die?”

What a stupid question. Of course he did. He wanted them all to die. It was why he’d come in with a gun.

“I can treat her. But I need to get instruments in the procedure room.”

“You think I’m an idiot? I’m not going to let you go off by yourself.”

“Then come with me,” Izzy said, desperate.

“And leave them alone?” He gestured around the waiting room. “I don’t think so. Sit back down.”

“No,” Izzy said flatly.

He raised his eyebrows. “What did you say?”

“No.” She began to walk toward the shooter. The gun was pointed at her belly, and her legs were like noodles, but she managed to take one step and then another until the barrel of the pistol was six inches away from her. “I will not sit down. Not until you let me get supplies so I can save that woman’s life.”

He stared at her for a moment that lasted days. Then he suddenly grabbed Joy and kissed the pistol to her head. “I’m counting to ten. If you do anything stupid, or if you don’t come back, this woman dies.”

A small, wounded whimper escaped Joy. Behind her, Bex was outright gasping for air. “One,” the shooter said.

Two. Three.

Izzy spun on her heel and raced down the hall to the procedure room. Four. She scrambled through drawers, flinging open cabinets, blindly grabbing whatever she could lay hands on as if this were a macabre supermarket sweep. Five. She lifted the hem of her scrubs top and dragged her booty off the counter and into the makeshift basket. Six. Seven.

She scrambled back to the waiting room, dumping her treasures all over the floor.

The shooter let go of Joy, who fell, trembling, onto the couch and drew her knees up to her chest.

“Pick those supplies up,” Izzy said to Janine. She pulled off the johnny she had draped over Bex. The woman’s eyes were wide and terrified; they fixed on Izzy as if she were the only mooring in a storm. “Bex,” she said firmly. “I know you can’t breathe. I’m going to fix that. I just need you to try to stay calm.”

Janine settled an armful of items beside Izzy: gauze and tubing and a number 15 stab blade, a Kelly clamp and a tenaculum, a curette.

Izzy was a pro at fixing problems with little but ingenuity. When the stove broke, you made a campfire and boiled eggs by holding them up to the steam coming out of a kettle. When there was no milk for cereal, water worked. When you wore through the sole of your shoe, you made an insole out of cardboard. If growing up poor teaches you anything, it’s how to problem-solve.

She picked up a 22-gauge needle. She had seen needle decompressions done before, but with bigger needles. This one was delicate, meant to inject lidocaine. It wasn’t long enough or stiff enough to provide a release for the air building up inside Bex’s chest cavity.

“Not gonna work,” Dr. Ward corroborated. “You’re going to have to put in a chest tube.”

She met his gaze over Bex’s body and nodded.

Izzy pulled the tubing from its sterile plastic packet. She reached for a Kelly clamp, and then picked up the stab blade. She wished she’d had the foresight to grab Betadine or an alcohol wipe, but this would have to do. Lifting Bex’s right arm, Izzy trailed her fingers to a spot between the fourth and fifth ribs and paused.

Just because she had seen this done didn’t mean she was qualified to do it herself.

“Go on now,” Dr. Ward urged. “Make the cut.”

She drew in her breath and pressed the scalpel deeply into Bex’s skin. A thin line of blood rose. Izzy stuck her left index finger into the incision and felt for the chest wall, blocking out Bex’s scream. She lifted the Kelly clamp with her other hand and slipped it through the incision.

“You’re going to have to push hard,” Dr. Ward said.

Izzy nodded and maneuvered the nose of the clamp above the rib, then punched through the chest wall with a pop. Immediately there was a whoosh of air, and blood spattered into her lap. Bex gasped, finally able to breathe.

It had been not just a pneumothorax but a hemothorax. Blood, not air, had filled her pleural cavity.

Izzy opened the clamp and twisted it back and forth to make a bigger opening in the chest wall. With her index finger, she felt the balloon of Bex’s lung as it rose and deflated. She pulled out the clamp, keeping its nose open so that she didn’t accidentally snag the lung. Keeping her finger still inside the chest cavity, she inched the suction tubing into the incision until it reached the tip. Only then did she slide her finger out.

Izzy didn’t have anything to hold the tube in place, or any way to suture it in. So she grabbed the plastic package that the tubing had come in and pressed it up against Bex’s side to make an occlusive seal. Dr. Ward reached for the tape that she’d used to secure his tourniquet and ripped off two pieces for her to secure the plastic.

“Miss Izzy,” he said, impressed, “if I didn’t know better, I’d think you were born to the ER.”

The tube had done its job: blood was running from the tube and dripping on the floor. Izzy wrapped a towel around the end of it, wishing for a container. With a container she could monitor how much blood Bex had lost. Eventually, if Bex didn’t get a transfusion, she would die.

Izzy felt a hand grab her shoulder. She turned to find the shooter holding a wastebasket. “Put it all in here,” he said, jerking his head toward the discarded instruments on the floor.

She gathered the needle, the tenaculum, the bloody Kelly clamp, and the items she hadn’t used, and threw them inside.

“Is that it?” he demanded.

Izzy nodded.

He waved the gun, gesturing that he wanted her to step back so that he could see for himself. Satisfied that nothing had been left behind, he backed away and set the wastebasket beneath the receptionist’s desk.

Bex grabbed her hand. She already looked more alert, and definitely more comfortable. “Thank … you,” she murmured. She tugged until Izzy leaned down.

Her voice was a prayer. Save my niece.