Warning Signs Read online

  Table of Contents

  Title Page

  Copyright Page

  Dedication

  ONE - Thursday, 5:21 A.M.

  TWO - Thursday, 6:52 A.M.

  THREE - Thursday, 7:26 A.M.

  FOUR - Thursday, 8:49 A.M.

  FIVE - Thursday, 8:57 A.M.

  SIX - Thursday, 10:11 A.M.

  SEVEN - Thursday, 10:34 A.M.

  EIGHT - Thursday, 10:38 A.M.

  NINE - Thursday, 10:58 A.M.

  TEN - Thursday, 12:27 P.M.

  ELEVEN - Thursday, 12:52 P.M.

  TWELVE - Thursday, 1:11 P.M.

  THIRTEEN - Thursday, 1:37 P.M.

  FOURTEEN - Thursday, 2:02 P.M.

  FIFTEEN - Thursday, 7:14 P.M.

  SIXTEEN - Thursday, 7:49 P.M.

  SEVENTEEN - Thursday, 8:41 P.M.

  EIGHTEEN - Thursday, 10:51 P.M.

  NINETEEN - Thursday, 11:22 P.M.

  TWENTY - Friday, 6:17 A.M.

  TWENTY-ONE - Friday, 6:51 A.M.

  TWENTY-TWO - Friday, 7:14 A.M.

  TWENTY-THREE - Friday, 7:47 A.M.

  TWENTY-FOUR - Friday, 8:11 A.M.

  TWENTY-FIVE - Friday, 8:26 A.M.

  TWENTY-SIX - Friday, 9:22 A.M.

  TWENTY-SEVEN - Friday, 9:32 A.M.

  TWENTY-EIGHT - Friday, 10:11 A.M.

  TWENTY-NINE - Friday, 10:28 A.M.

  THIRTY - Friday, 10:51 A.M.

  THIRTY-ONE - Friday, 11:18 A.M.

  THIRTY-TWO - Friday, 12:27 P.M.

  THIRTY-THREE - Friday, 12:38 P.M.

  THIRTY-FOUR - Friday, 2:11 P.M.

  THIRTY-FIVE - Friday, 3:29 P.M.

  THIRTY-SIX - Friday, 3:57 P.M.

  THIRTY-SEVEN - Friday, 4:11 P.M.

  THIRTY-EIGHT - Friday, 4:38 P.M.

  THIRTY-NINE - Friday, 7:22 P.M.

  FORTY - Friday, 7:51 P.M.

  FORTY-ONE - Friday, 8:18 P.M.

  FORTY-TWO - Friday, 8:42 P.M.

  FORTY-THREE - Friday, 8:54 P.M.

  FORTY-FOUR - Friday, 9:12 P.M.

  FORTY-FIVE - Friday, 9:52 P.M.

  FORTY-SIX - Friday, 10:11 P.M.

  FORTY-SEVEN - Friday, 10:14 P.M.

  FORTY-EIGHT - Friday, 10:16 P.M.

  FORTY-NINE - Friday, 10:24 P.M.

  FIFTY - Saturday, 3:12 A.M.

  Special Excerpt from Urgent Care

  NOTE TO READERS

  About the Author

  MORE PRAISE FOR THE NATIONAL BESTSELLER

  LIFELINES

  “[A] spot-on debut … a breathtakingly fast-paced medical thriller.”—Publishers Weekly

  “Forget about your plans for the day and prepare to be swept away on a pulse-pounding adventure. This is my favorite kind of medical thriller—harrowing, emotional, action-packed, and brilliantly realized. CJ Lyons writes with the authority only a trained physician can bring to a story, blending suspense, passion, and friendship into an irresistible read.”

  —New York Times bestselling author Susan Wiggs

  “A pulse-pounding adrenaline rush! … Reminds me of ER back in the days of George Clooney and Julianna Margulies.”

  —New York Times bestselling author Lisa Gardner

  “Have we got a prescription for you … a tense thrill ride that feels like all the best episodes of ER and Grey’s Anatomy squeezed into one breathtaking novel … [an] impressive debut.”

  —Hilton Head Monthly

  “CJ Lyons writes with both authority on her subject and a down-to-earth reality for her characters … Engrossing, intriguing.”

  —New York Times bestselling author Heather Graham

  “CJ Lyons’ debut medical thriller is a fantastic and wild journey through the fast-paced world of a big-city ER. With rich, fascinating, and complex characters and a thoroughly compelling mystery, Lifelines is an adrenaline rush and an all-around great read.”

  —New York Times bestselling author Allison Brennan

  “Lyons captures the frenetic setting of the ER with a smooth style that demands the reader move forward to keep up with the pace, but she also creates winning portraits of the supporting players set to anchor the series … Sets the table well for the next adventure at Angels of Mercy.”—Newsday

  “If this debut novel is any indication, [Lyons’] decision [to write books] could be a gift to readers of multiple genres … Lydia is a well-drawn heroine, the writing is strong, and the plot could have been taken out of today’s headlines.”—Pittsburgh Post-Gazette

  “Lyons’ first book is a winner, too, giving us terrific characters and a compelling plot. An excellent book for fans of the medical thriller.”—Fresh Fiction

  “It takes a real emergency physician to write this excitingly about an emergency ward. CJ Lyons has been there and done it. The pages are packed with adrenaline. I can’t recall a hospital novel that so thrilled me.”

  —New York Times bestselling author David Morrell

  Titles by CJ Lyons

  LIFELINES

  WARNING SIGNS

  Warning Signs

  An Angels of Mercy Novel

  CJ Lyons

  INTERMIX BOOKS, NEW YORK

  INTERMIX BOOKS

  Published by the Penguin Group

  Penguin Group (USA) Inc.

  375 Hudson Street, New York, New York 10014, USA

  USA | Canada | UK | Ireland | Australia | New Zealand | India | South Africa | China

  Penguin Books Ltd., Registered Offices: 80 Strand, London WC2R 0RL, England

  For more information about the Penguin Group visit penguin.com

  This is a work of fiction. Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to actual persons, living or dead, business establishments, events, or locales is entirely coincidental. The publisher does not have control over and does not have any responsibility for author or third-party websites or their content.

  WARNING SIGNS

  An InterMix Book / published by arrangement with the author

  PUBLISHING HISTORY

  Jove Books edition / February 2009

  InterMix eBook edition / March 2013

  Copyright © 2009 by CJ Lyons.

  Excerpt from Urgent Care copyright © 2009 by CJ Lyons.

  All rights reserved.

  No part of this book may be reproduced, scanned, or distributed in any printed or electronic form without permission. Please do not participate in or encourage piracy of copyrighted materials in violation of the author’s rights. Purchase only authorized editions.

  For information, address: The Berkley Publishing Group,

  a division of Penguin Group (USA) Inc.,

  375 Hudson Street, New York, New York 10014.

  ISBN: 978-1-101-60833-3

  INTERMIX

  InterMix Books are published by The Berkley Publishing Group

  and New American Library, divisions of Penguin Group (USA) Inc.,

  375 Hudson Street, New York, New York 10014.

  INTERMIX and the “IM” design are trademarks of Penguin Group (USA) Inc.

  ALWAYS LEARNINGPEARSON

  Thanks to my readers,

  who have made this dream-come-true of

  writing for a living so fulfilling,

  to my critique partners for keeping me on my toes,

  and to my family for their patience.

  This book is for Jeff,

  lost too early,

  but still an inspiration and never forgotten.

  ONE

  Thursday, 5:21 A.M.

  AMANDA MASON TILTED HER FACE TO THE wind, trying in vain to detect any hint of
the ocean in the predawn darkness. Nothing. Only the rancid odors of diesel fuel and machine oil.

  It was warm enough to feel like home, even out here on the Allegheny River, the sun not due up for another two hours. Going in this direction, away from the Ohio and upstream to the boathouse on Washington’s Landing, the wind was full in her face, sharp enough to bring tears.

  It had to be the wind. She was twenty-five years old, a grown woman, a fourth-year medical student who daily held lives in her hands. There was no way she was homesick.

  The scull passed beneath the Roberto Clemente Bridge, accompanied by the rumble of a truck passing overhead, echoing through the dark. Amanda emerged on the other side in time to watch the firefly sparks of a discarded cigarette somersault and vanish. A horn sounded on the river-bank, followed by the scream of a siren. Definitely not home. But she most definitely wasn’t homesick. Not at all.

  She finished her trip up the Allegheny and pulled the rowing shell from the water. She already felt the effort in her shoulders—would feel it more by tomorrow, she was certain. It had been a few months since she’d had the chance to row. The life of a medical student doing clinical rotations was anything but predictable—especially as she’d had some of her most difficult rotations this summer and fall: emergency medicine, oncology, pediatric surgery. But not this month. This month should be a cakewalk. Neurology. Strictly consults, no overnight call in the hospital. This month she’d take her life back. She vowed to find more time to go to the boathouse; she’d forgotten how invigorating it was to start the day out on the water.

  “Here, let me help you with that,” Jared, the boathouse manager, said, appearing from the shadows of the large overhead doors that led into the boathouse.

  “What are you doing here so early?” Amanda asked, grabbing the oars as he easily lifted the shell. Jared was short and stocky with red hair that had earned him the unimaginative if apt nickname of “Carrot-Top,” but he was always helpful and ran the boathouse with admirable efficiency.

  “My girlfriend is training for another marathon, gets up around four, so I figured why not come in early? No sense trying to go back to sleep.”

  Together they stowed her shell, and he followed her up the stairs to the locker rooms and social hall. “Do you have any more of those flyers about the research studies over at Angels? Folks have been asking for them.”

  “Yes, I brought some. Wasn’t sure where to post them—” She gestured at the black-framed photo that had replaced the usual collection of flyers, announcements, and advertisements on the community bulletin board next to the locker rooms. In it was a picture of a smiling girl, the boathouse’s assistant manager. Below it was a memorial plaque.

  Amanda reached out and stroked the side of the frame. “I didn’t even know about Shelly until I came in this morning and saw this.”

  “We posted it on the e-mail loop.”

  “I went nomail when things got crazy at school. What happened?”

  Jared shrugged, his lips tight as he regarded Shelly’s photo. “Don’t know. Her husband isn’t really talking about it. It was so sudden,” he said, straightening the frame she’d knocked crooked.

  Amanda sighed. She saw grieving families every day—and still hadn’t gotten used to it. “I’d better get changed or I’ll be late.” She pushed open the door to the women’s locker room and stopped, looked back. “I’ll leave the flyers on the desk.”

  Jared said nothing, but merely nodded, his gaze fixed on Shelly’s bright smile.

  A SHORT TIME LATER, HER HAIR STILL DAMP from her quick shower, Amanda raced down Pittsburgh’s Angels of Mercy Medical Center’s east stairwell, the echoing sound of her clattering heels reminiscent of rain tap-dancing on a tin roof, taking her home to rocking chairs, sweet tea, and her mother’s veranda.

  Her pager screeched, obliterating the illusion. The pulse-jarring noise propelled her into an instant state of alertness. Worse than Pavlov’s dogs, Amanda thought, hating the gut-twisting adrenaline surge that hit her stronger than any caffeine jolt.

  She silenced the pager and clutched the stethoscope jostling around her neck, barely catching herself as she rounded the landing. Her coat pockets bristled with notebooks, index cards, and neurology manuals. The books were heavy enough to swing the coat like a pendulum, throwing her off balance as she dashed down the stairs to the ER.

  The ER, which would not stop paging her. She quieted the beeper again. “I’m coming, I’m coming,” she said aloud, startling the janitor mopping the landing below her.

  He glanced up, but didn’t bother to move out of her way once he caught sight of the short lab coat marking her as a mere medical student, or “scut-monkey” in hospital parlance. The lowest of the low, actually paying for the privilege of running labs, starting IVs, jabbing poor unsuspecting patients for blood, and stroking attending physicians’ egos.

  Amanda skidded across the wet floor, grabbing the door handle to stop herself before she slammed into the concrete wall. Her short heels were comfortable but not designed for galloping down stairs in response to a summons from the ER for a stat neurology consultation.

  A lady never rushes. Her mother’s oft-repeated instruction returned to her. Amanda took a breath, smoothed her lab jacket, and straightened her stethoscope. She closed her eyes for a moment, trying to recapture the serenity she’d felt out on the river, rowing in the predawn mist that huddled over the Allegheny.

  Then she calmly strode through the door—with three older brothers to keep up with, her mother had never been successful in getting her to glide like a proper lady—and entered the vortex of humanity that was Angels of Mercy’s Emergency Department.

  “What are you doing here?” Nora Halloran, the ER day-shift charge nurse greeted Amanda, glancing up at the clock.

  “You called for a neurology consult?” Amanda tried to sound confident, as if a fourth-year medical student could actually contribute something useful. She still broke out in palpitations every time she remembered that this time next year she’d be a real-life, full-fledged doctor. How could one person ever hope to learn everything she needed to know in such a short time?

  “Not me, I’m not on the clock yet.” Nora’s hazel eyes gleamed as she took in Amanda’s dress and heels. “You aren’t either—not until seven. Trying to impress someone special?”

  “Please.” Amanda’s Southern accent drew the word out into two syllables. She straightened her posture, tucked an errant strand of blond hair behind her ear, and attempted to look calm, cool, professional. “No, I have a doctor’s appointment later, is all.”

  “Pretty nice dress for a doctor’s appointment,” Nora continued. “Who’s the doctor, George Clooney?”

  Amanda smiled at the compliment. She’d chosen the blue linen dress to match her eyes, and she felt good wearing it. After spending her last rotation mainly in the OR, stressed out and sleep-deprived, wearing scrubs and blood-splattered Reeboks, she had rejoiced in the opportunity to dress like a real person again, pulling all her favorite girl clothes from her closet.

  “No, it’s Dr. Nelson. Last time I saw him, I was working the ER, hadn’t slept in two days or had a chance to shower. I wanted him to see that I know how to take care of myself.” Another reason why she’d gotten up before dawn and headed over to the boathouse on River Avenue. She’d neglected her rowing—or any exercise—for several months, and she was determined to put herself and her health ahead of her studies for once.

  The door to the resuscitation room banged open. A dark-haired woman craned her head out, her gaze sweeping across the ER, looking for trouble. Dr. Lydia Fiore, the youngest and newest ER attending, gave Amanda an abrupt nod. An alarm blared and she vanished back into the room.

  “Guess I know who paged me,” Amanda said, leaving Nora for the resuscitation room, her heels clacking against the linoleum with an authority she didn’t feel.

  She liked Lydia, enjoyed working with her, but the attending’s boundless energy and ability to make diagnoses with
minimal information could be a bit overwhelming and intimidating. Even the regular ER staff was polarized by Lydia—either in awe of her apparently magical abilities or scornful, waiting and hoping for her downfall. Lydia didn’t seem to notice or care, instead focusing all her energy on her patients with a self-assuredness Amanda envied.

  Pushing open the door to the treatment room, Amanda entered a symphony of chaos. Nurses and lab techs swarmed around a motionless black girl, maybe twenty years old, who lay on the exam table, colored wires leading from her chest to a monitor, two IV lines in place, a respiratory tech adjusting a nonrebreather oxygen mask over her face. Elise Avery, the flight nurse who must have transported the patient in on the hospital’s helicopter, was directing traffic, a scowl on her face.

  The only oasis of calm was Dr. Fiore herself, who stood motionless at the head of the bed, one hand resting against the girl’s shoulder as if giving comfort. Except Lydia wasn’t really still. Her gaze was in constant motion, devouring everything in its path, and one foot tapped an impatient staccato that mirrored the beeping of the heart monitor.

  Gina Freeman, an emergency medicine resident and Amanda’s roommate, had once compared Lydia to a hand grenade—not much to look at on the outside, but ready to explode when triggered.

  “Nineteen-year-old collapsed during a cross-country run this morning, transported in from Millvale,” Lydia told Amanda. “On arrival, she was unresponsive, noted to have hypernatremic dehydration with an elevated sodium of one fifty-one. Vitals were normal, but patient grew increasingly nonresponsive with myoclonic movements of her extremities and eventually exhibited a descending paralysis. I was just getting ready to intubate her, but thought you might want to do a quick exam first.”