Chapter One

FOB Imperia Military Hospital, Khost Province, Afghanistan
August, 2009

I’ve wanted Rebecca Keane from the moment I first saw her perform surgery. I’d only been deployed for three days on my first tour and instead of concentrating on our patient, I found my eyes drawn to the strands of wavy blond hair that had escaped her scrub cap. Wide, dark blue eyes creased when she smiled over her mask at me and I forgot how to verbalize, mumbling something stupid about a liver.

My shallow thoughts about her beauty took a backseat when I saw how effortlessly she negotiated what seemed to be a lost cause. Confident, yet never demanding. Skilled and calm. She tilted her head as she asked my opinion, then her eyes held mine as she agreed with it.

My want of her isn’t anything deep or well thought out, but more the way you see a coat in a store window and think right away I want that. Then you remember you already have a coat. A coat named Victoria that’s been yours for almost nine years.

* * *

I run with sluggish footsteps and a wandering mind, trying to take my thoughts away from here. Away from war, bullet wounds and dismembered limbs. Away from the dust and dry heat of Afghanistan and a man I couldn’t keep alive. Away from the expression on Keane’s face when I told her I’d lost him. Away from her look of disappointment and away from my own failure.

It’s not working. I can’t stop thinking about it. I need a better distraction or I’m going to cry. I shove my thoughts to the opposite end of the scale. Instead of disappointment, I imagine Keane giving me a look that is lustful. Perhaps as I push her against the wall of a shower cubicle and kneel to slip my—

“Sabine.” Mitch interrupts thoughts that are fast becoming inappropriate.

“Mmm?”

He isn’t even panting. “You’re fuckin’ slow. My mama runs quicker’n you.”

The fantasy is gone. I slide my tongue over dry lips as I turn my head toward him. Even in sunglasses, I’m squinting and the dust in my mouth coats my tongue like a gritty blanket. I can’t think of a witty comeback. I’m going to have to let this one go. Slow, my ass. I clamp my lips together and increase my pace.

Mitch moves ahead. I try to keep up. He laughs and increases his speed again, taunting me. I drop my shoulders and burst into a sprint. We race each other around the track, jostling and giggling, and I manage to keep up with him for twenty feet or so before the length of his strides allows him to break away. Mitch Boyd, my best friend and a fellow surgeon, is well over six feet tall and athletic. I can’t compete when he decides to outpace me.

With his beefy arms raised to make a V above his head Mitch crosses an imaginary finish line. He tosses his cap high in the air before bursting into a warped victory dance. The smug bastard looks ridiculous as he shakes his ass and I’d tell him so if I wasn’t so breathless. I reach him as he leans down to pick up his hat.

“Really thought you could outrun me? Maybe you should borrow some stilts,” Mitch teases in his molasses drawl. His voice always reminds me of barbeque on a Sunday afternoon. Texan and stupidly good-looking, he would probably be my type if my type had balls. I suppose it’s possible I’d be Mitch’s type, if his type had tits.

I manage one word between gulping air. “Asshole.” My friendly punch goes wide, hitting Mitch’s shoulder as he straightens. He recoils in mock horror, as though my fist actually registered instead of just glancing off his bulk. I swat him again as we begin a cool-down lap around the track. Somehow a dead bug has made its way into my mouth.

Mitch tugs his cap on. “I got an interestin’ email yesterday.”

“Yeah?”

“There’s a rumor Congress is gonna repeal Don’t Ask, Don’t Tell.”

I scoff. “I doubt anything will come of it. It’ll take years to reverse policy. If the bill even gets through.” And I don’t hold much hope it will. The army policy on gay and lesbian service members is clear. Keep it to yourself and do your job.

“You never know, darlin’. It could happen. Then you can invite Keane to come stay the night in your bed. I know you’ve got a little crush going.” Mitch caught me eyeballing Keane when we first arrived on base and he refuses to let it go. He’s not wrong, I do have something, but it’s not just a schoolgirl crush.

Rebecca Keane. My boss. Dimpled. Accomplished and inventive surgeon. Owner of a number of very pleasing physical attributes. Wearer of my favorite perfume. Flag football devotee. Most certainly an excellent lay. Shorter than me, I could probably pick her up and carry her to a bed. Don’t start that shit again, Sabine.

Mitch is waiting, watching me with an eyebrow raised. I’m so busy fantasizing that I haven’t responded to his teasing. I fling my arm out to hit him. “Don’t even start. As if you haven’t got your eye on someone too.”

Mitch stretches his arms up luxuriously. “The list is longer’n my arm.”

I raise my eyes to the sky. Of course it is. We continue walking without speaking—our friendship is long past needing to fill silences with inane conversation. We’re halfway around the track when the siren starts with a persistent screech that reverberates through my bones. Speakers across the base blare an “Attention on the FOB!” message to tell us casualties are on the way.

Our FOB, Forward Operating Base Invicta, is a secured area in a massive, miles-wide valley between stunningly stark mountain ranges. We’re one of the smaller units and the hospital is our most important feature, but you wouldn’t know to look at it. It’s deliberately unremarkable—nestled among the obligatory military structures of quarters, mess halls and equipment sheds.

Everything at Invicta is laid out with pleasing symmetry in uniform colors of cream, khaki and brown. Some buildings are permanent, or as permanent as things get around here. Others, like the mailroom, are plywood shacks that amazingly never fall down when a hot windstorm blows through.

All day and night the base hums with people at work inside the fence, locals outside it, and transports coming and going. In high wind, the razor wire and chain-link fence encircling Invicta rattles and clinks. I live with constant noise and dirt. I live with the omnipresent smell of diesel, dust and aircraft fuel. I live with other people’s blood on my uniform.

The incoming alert keeps blaring. It reminds me of a smoke alarm. I feel it like fingers gripping the back of my neck, forcing me to respond. I can’t ignore or sleep through the sound. No matter how tired I am after thirty-seven hours running on adrenaline, bad food and coffee, I will wake up and I will respond. Some of the more experienced team members tell me they can feel the helicopters approaching before they hear them. Maybe on my next deployment I’ll somehow gain this extra sense but for now I have to rely on regular old hearing. I stop, hold my breath and strain to listen for the heavy thrum of the helicopter rotors.

Mitch shields his eyes, pointing out toward the horizon. “I hear the birds over yonder.” This means we have maybe seven minutes. He breaks into a sprint just before I do and our feet leave heavy prints on the dusty ground as we race one another again, only this time it’s not for fun. Fucking assholes. Goddamned fucking assholes. I’ve already been in surgery for over eight hours today. I’m hot, sweaty and tired. I should be getting ready to enjoy some personal tension relief in a shower cubicle.

The air-conditioning shocks me when I burst into the building and a deep shiver builds at the base of my neck. I tug at my shirt as we jog through the hallways among other Medical Corps personnel. Most of them are also pulling pieces of uniform off as they move. My sweaty shirt sticks to my skin as I try to yank it over my head. I grunt as I wrestle with it, my hip hitting the wall. Frustration burns in my throat but I push it back down. I need to be calm, focused and professional. Not some idiot ranting about a T-shirt.

Bobby Rodriguez, one of our anesthesiologists, and John Auger, a general surgeon like Mitch and me, reach the pre-op prep room as we do. I pause to let them pass and Rodriguez looks at me, wearing his best shit-eating grin. Outside the theater I am fair game, but once inside he wouldn’t dare. I greet them breathlessly. “Bobby. John.”

“Hey runners.” Rodriguez drags his words out. “Timely interruption. Wouldn’t want you two getting even hotter out there.” The joke is old and tired.

There are rumors on base about Mitch and I being involved. We do not confirm, or deny because it’s easier to maintain a charade than to risk exposure. Sex is everywhere here, and yet it is nowhere. It’s something we talk about constantly, but at the same time it’s not allowed.

Bobby and John grin at us. Mitch rewards them both with a hard back slap. This ritual is some unspoken bro code that I can never be part of. Every night, men all over the world sit in bars, get physical with each other and discuss their latest conquests.

“Did you fuck her?”

“You fucking bet I did. She could suck a melon out the tailpipe of a sixty-five ’Stang.”

Cue masculine laughter, more back slapping and another round of beers.

If women had a ritual, it would probably be the age-old question asked over a glass of wine: “Did he make you come?” A wry smile would be the response. No. Of course he didn’t.

The grin I give the boys is forced. See? I’m part of the game too. Mitch holds the door so I can slip through. He turns to me, his blue eyes wide and I suppress a laugh. Yes, Mitch, I know it’s an act for you. I leave him and cross the room without looking at anyone else.

I’m an automaton. My equipment locker is orderly, everything organized within easy reach. I quickly unfasten my thigh holster and leave my weapon on the shelf. Hop around to pull boots off, wet wipes to get rid of dust and sweat, back into scrubs. Chug some water, wristwatch off and drag my hair into an even tighter bun. The ends feel ragged, like it’s dangerously close to being out of regulations. Tomorrow I will go to the base salon to have a few inches lopped off.

I catch sight of myself in the mirror stuck to the back wall of my locker. My dark eyes appear almost black from the reflection of shadows nestled under them. I look tired. Is that a line near my nose? I lean closer, rubbing at my face. No. Good. Thirty-five is too young to have wrinkles.

The room has filled in the three minutes I’ve been in here. Conversation hums around me. Doctors. Nurses. Men. Women. All in various stages of dress and undress. All pay grades. All ranks. No wandering eyes. In here, we’re sexless. Anticipation and adrenaline, and perhaps profound fatigue cause a slight tremor in my knees, but not my hands. My hands are surgeon’s hands. They do not waver. I pull on my scrub cap and tie a tight double knot.

The door connecting the prep room to the scrub area and theaters swings open. “We have three incoming, ETA five minutes. IED. Four lower amps, one upper. Blast trauma. We’ll know more when they arrive.” Her voice. Cultured. Mellow. Sexy.

Stop it Sabine.

Lieutenant Colonel Rebecca Keane stands in the doorway holding her cap. She now has everyone’s undivided attention, which isn’t difficult. Perhaps ten years older than me, she has an empathetic yet commanding air. Her manner is straightforward and confident, but never belittling. I classify all of these as important qualities for a boss and team leader. I also classify her as extremely attractive.

I look away and force myself to focus. IED. Improvised Explosive Device. When I first heard the term, I imagined someone hastily cobbling a bomb together with whatever they had lying around. I mused to myself about how bad it would really be if they put some effort into it.

Now on my second deployment, I know better. Improvised doesn’t mean a fucking thing. Four lower and one upper from three casualties. I do the math. Today, a soldier might have lost both legs and possibly an arm. War. What is it good for? Not much it would seem.

“Captain Fleischer!”

I straighten, turning toward Keane with my chin lifted. “Ma’am?”

Keane keeps her eyes on me. “You, Auger and Rodriguez take casualty A with Thorne for ortho.” She assigns all the other surgeons into teams as I’m pulling shoes back on. I finish my laces then look up in time for the last of her briefing. “…you all know the drill. Nice and steady, no mistakes.” Keane’s eyes sweep the room, lingering on me for a moment before she exits.

Wait. I have a brief moment of panic as I mentally run through my past three days in surgery. Does she think I made a mistake this morning? That was unavoidable. Nobody could have saved him. I can’t think of anything else. All my reports are completed and I’ve only lost one patient this week. Less than everyone else. Shit.

I pause, tuck a wisp of hair into my cap and rush after her, intending to ask if there’s anything amiss. Mitch grabs my arm before I reach the doors. “Good luck,” he says, eyes bright.

My gaze moves to the swinging doors. Keane is gone. “Luck is for suckers.” It’s our standard response. I pull my arm free and leave him to assemble with the members of his team.

Chapter Two

Hot wind sweeps in from outside as three casualties are rushed through in a flurry of bloodied uniforms and rank body odor. I finish pulling on disposable gloves and quickly tie my gown in the back. This crew is one I’ve never met before. I throw a hurried introduction at them. “I’m Doctor Fleischer. Bring A into this bay here please.”

One of the Combat Pararescuemen—PJs we call them—turns to me. “ALOC since the blast, been given packed blood. Below knee and partial arm amp.”

Altered Level of Consciousness could mean anything. Seems this guy is very new and needs his hand held a little. “Has he been conscious at all?” I ask.

“Briefly ma’am, at first contact.”

“Okay, let’s roll him on.” We transfer the casualty onto the gurney, careful not to dislodge the lines attached to his body. He is extremely pale, his torso heaving with ragged breaths. Hello shock, hello massive hemorrhage.

I run my hands over the man on the stretcher and make mental assessments while more stats and details of drugs administered are thrown at us. The fetid tang of blood and voided bowels from the patient’s hastily-removed uniform hangs in the air. Facial trauma, one arm, one leg and two messy stumps. What shitty fucking luck. I almost let out an audible sigh, but catch myself and cover it by clearing my throat. We rush through the rest of our checks and he is taken from the assessment bay to the theater.

Bobby is already in there when I bump up against the scrubbing sink and reach for a mask. I fit it carefully, tying it with more double knots. The disposable nail pick digs into the sensitive skin of my nail bed. My nails are short and scraped many times a day. Nothing ever accumulates under them.

My gaze moves between my hands and the window in front of me where I can see nurses unpacking sterile kits and placing instruments onto trays. My favorite nurse Sarah pauses to respond to a question from Bobby then rushes away to keep prepping.

After many months of operating with me, they all understand how I like my trays laid out. When I walk into the theater I know my forceps will be set at the perfect angle against my clamps and I’ll have exactly the right scalpels and needle holders. Mitch calls it OCD. I call it organization.

The iodine impregnated scrub sponge has an odor that sticks to the inside of my nose. The scent will stay there for at least ten minutes, assuming nothing more noxious invades my nostrils. Nate Thorne and John Auger step in beside me, reaching to pull a mask each from the box on the shelves above us.

“I fucking hate IEDs.” John’s Boston accent is more pronounced than usual. He’s upset. “Give me a bullet any day. Something we can fix. Not this chop and drop bullshit and a ‘Sorry we couldn’t fix your limbs because some prick blew them off and they are God knows fucking where’ speech at the end.” The muscles of his cheeks bulge as he vents and he finishes with his molars clamped tightly together.

John loathes injustice and hates to be ineffectual. Lately it feels as though these two things are in steady supply around here. His ranting is nothing new and I’ve heard it almost every day for the nine months we’ve been deployed together. Ninety-two days left on this, my second deployment, until I am rotated out. Ninety-two more days of listening to him going on and on about things which are out of our control. You can do it, Sabine.

Nate says nothing. He’s shy, one of those people who blends into the background, and he rarely talks unless it’s to ask for something during surgery. I stay silent too, but nod to show I’m not ignoring John. His words fade out into background noise and my mind wanders. My hands and forearms are now stained yellow-orange. I think of Oompa Loompas. I think of watching movies with my younger sister.

When I was fifteen, I decided I wanted to be a surgeon. My sister Jana was the first person I told. I expected encouragement but instead, she laughed at me. When she was done, she asked me how someone so prone to random thinking could manage to focus long enough to perform surgery. Some days I’m not even sure how I do it myself. On days like today, days when someone dies, I almost feel like I’m just playing at being a doctor.

“Doctors?” Sarah stands at the window in front of us, her voice soft behind the glass.

Nate glances up, and John and I answer together. “Yes?”

“Are you ready to get going?”

She’s telling you to hurry up, Sabine. I splay my fingers and scrub harder. John resumes talking. I think I catch the word occlusion. He must think about surgery constantly. I’m not really listening, so I don’t know what to say in response. I make a musing sound. Good enough. When I’m not in the operating room, I want to think about anything but surgery. I want to think about my pets, the beach, skiing, dancing and drinking. Maybe my girlfriend. My family.

I became a surgeon because it was what I wanted. I joined the army because my family boasts three generations of military service before me. My great-grandfather fought and died in World War I, leaving a young son for the second. After he’d done his duty in World War II, my grandfather grabbed his pregnant wife and they left Germany for America. Oma and Opa produced three sons who the New Homeland gobbled up eagerly for the Vietnam War. Only one was regurgitated. My father.

I once gave a brief summary of my family background to Mitch and watched with amusement as he made the connection. During both World Wars, my family fought for the other side. I told him I’m proud of my heritage. I didn’t tell him how as a surgeon, the literal translation of my German last name to The Butcher delights my dark sense of humor.

Anguished wails from the operating room beside mine startle me out of introspection. It’s something I’ve never quite got used to, listening to them before they are anesthetized. No doubt, I’d be making similar noises if our situations were reversed. Be honest, Sabine, you would be louder.

I glance at the clock on the wall, bump the faucet handle with my elbow and bend to get my arms under the flow. “See you in there.” Before either of them answer, I push backward through the door to the theater.

When I spin around I come face-to-face with Sarah, holding a ready towel. While I dry my hands and arms, my gaze drifts to the table where the patient has been settled prior to being knocked out. Everyone bustles around me. Another nurse wrestles with the x-ray and CT machines, trying to get images up for us to work with while Bobby runs another vitals assessment. I’m tempted to speak up to tell Bobby my expert medical guess is that the patient’s vitals are present, but unimpressed with current body conditions. He probably wouldn’t find it funny.

Sarah already has my gown ready and I slide forward into it with arms outstretched. I turn for her to tie the straps and when I rotate back around she offers a right glove ready for me to dive into. I give my fingers a quick wiggle to seat them before she hands me my left glove. We dance this dance many times a week and she knows my routine so well it’s like she lives inside my head. Poor woman. My fingers interlace, ensuring the thick latex is snug against my skin. I lean forward so Sarah can fit protective glasses over my eyes. She smiles when I wink at her.

Each moment we wait increases the risk, but I can’t begin until the patient is intubated. Time is written on his stumps in black marker, telling me when tourniquets were applied. They have been on those limbs for almost an hour and a half. I fidget. “How’s it going, Bobby?”

“Can’t get him yet, Sabs. His larynx is ground beef, not much left of his mandible,” Bobby responds. “Glidescope please, I’m going to video-assisted.” Sweat is beading along his sideburns. Bobby rarely sweats. There is no point demanding he hurry up. I know from experience that being pushy gets us nowhere.

One of the nurses turns to me. “Images are up.”

“Thank you.” I glance at Bobby one more time, then stride across the linoleum to the monitors. I’m impatient, which makes everything feel like it doesn’t fit right. I roll my shoulders to shift the gown, wrinkle my nose against the material of the mask and make a conscious effort not to check the progress of the intubation. He won’t go faster if you’re leaning over his shoulder, Sabine.

I focus on the images in front of me, tracing organs and structures quickly with my eyes. His intestines are a mess, but repairable. I don’t think you’ll need a colostomy, sir. Moderate internal blunt force blast trauma. Lucky man. Relatively speaking.

John sidles up beside me, his eyes sweeping the images. “Messy, but not the worst.” His pale blue eyes move from the monitor to my face. “You good?”

I nod and take another moment to ensure I’ve got all the information I need. Behind me, I hear Nate’s small sound of agreement.

“We’re golden, guys. He’s on.” Bobby sounds relieved. He hooks up the anesthetic machine and tosses his laryngoscope onto a tray.

The team gets right to work. I’ve performed so many surgeries like this that it’s all muscle memory and I barely even have to think. We converse, but it’s all mundane and focused on the casualty, except for ten minutes where Bobby chatters about an upcoming preseason Bears game. John and I exchange exaggerated eye rolls. The nurses snigger. We’ve all heard Bobby’s Bears predictions before. They’ll probably lose the game. Nate murmurs something about the Broncos.

“Can I move up?” John asks. He wants the space.

“Give me a moment, I’ve got a little bleeder.” I glance up.

“You got it?” he asks calmly.

It only takes a few moments to control. “Yep, done.” We all shuffle around, except for Bobby who is sitting down with his legs outstretched. Lazy prick.

* * *

When John and I are both satisfied we’ve done all we can, my personal complaints can finally be acknowledged. After almost four hours of surgery, a deep ache has taken up residence in my left shoulder and gnawing emptiness turns my stomach. I haven’t showered in over thirteen hours, three surgeries and one twenty-minute run. I feel disgusting and I really need to pee. We finish up and leave Bobby to recover the patient.

I drop my dirty gown and gloves into the hazardous waste receptacle and before I can reach for the chart, Sarah is holding it out to me. I’m wriggling my toes inside my boots, trying to ignore insistent messages from my bladder. The patient’s name is Corporal Gleason. “Call me as soon as he’s awake please.” Sarah nods, giving me an accommodating smile while I sign my name at the bottom of the last page. “Thank you.” I snap the chart closed and pass it to John.

Scrubbing out takes a few minutes and I use the time to run through the surgery. I relive each step for the report, which I’ll begin as soon as I shower and change. The sound of water has woken my bladder up. I begin to jiggle. The paper towel sticks as always and I have to tug it hard to get the dispenser to relinquish a square for me to dry my hands. Piece of shit equipment. Someone clears their throat, startling me. I hadn’t noticed Colonel Keane at the sink to my right. I sneak a look at her.

Keane shakes her hands out, not bothering to dry them before she pulls her cap off. The lighting in this room highlights the deep gold tinge in her blond hair. I toss the paper towel and try not to stare as I wait for her to approach me. Outside the operating rooms there is no need to salute but I lift my chin and straighten up. “Ma’am.”

“Initial surgical report, Captain?” Her tone is crisp, but her dark blue eyes are not.

John and Nate are still in the theater, so it’s on me to report. I run my tongue over my lower lip before speaking. “Casualty is on his way to recovery, Colonel. Nate attended to the amputations and we’ve left the sites open. We’ll watch for infection, then tidy up more when we’re more certain about viability. John and I repaired damage to liver and large intestine. There was a small amount of bleeding but we were able to contain it. I expect no issues.” I feel like a younger version of myself, the nerdy teen with braces having to explain a complex math equation to the class.

“Very good. I expect the written by tomorrow.”

I’ll have it completed sooner than that. “Of course, ma’am.” I pause and take a shallow breath. “Have there been any issues with my other surgeries or reports from this week, Colonel?” Worry sits uncomfortably in my chest, the sensation of thinking something I’ve done may not be good enough.

Keane stares at me, the crease between her eyebrows deepening. “No Sabine. Why would there be?”

“No reason, ma’am, I just thought…” What am I going to say? I was watching you and I saw you watching me when you mentioned mistakes? Of course not. I clear my throat. “I just wanted to make sure everything was in order, ma’am. You seemed disappointed in me, in my outcome from this morning.” I’m acutely aware of how pathetic I sound.

Keane gives me a patient smile. “Disappointed? I was, yes. For you, not in you, Sabine. Everything is fine.” Her left cheek is creased with a dimple. I try not to look at it.

I exhale, releasing a fraction of my anxiety. “Thank you, ma’am.”

Keane folds her scrub cap in half. “Enjoy the rest of your day.” She nods her dismissal of me and walks off.

My eyes stray to her ass as she leaves the room. “You too, Colonel.” I count off thirty seconds to be sure she is gone, then race to the bathroom.