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lights were too bright and they were shining right in his eyes. They seemed to be getting brighter.
    "Pull right!" screamed Chuck. "It's a car! Pull right!" Vince veered right. So did the lights.
    He heard a shriek, unfamiliar, unearthly.
    Not Chuck's, but his own.
    Dr. Abby DiMatteo was tired, more tired than she'd ever been in her life. She had been awake for thirty straight hours, if one didn't count her ten-minute nap in the X-ray lounge, and she knew her exhaustion showed. While washing her hands in the SICU sink, she had glimpsed herself in the mirror and had been dismayed by the smudges of fatigue under her dark eyes, by the disarray of her hair, which now hung in a tangled black mane. It was already 10 a.m., and she had not yet showered or even brushed her teeth. Breakfast had been a hardboiled egg and a cup of sweet coffee, handed to her an hour ago by a thoughtful surgical ICU nurse. Abby would be lucky to find time for lunch, luckier still to get out of the hospital by five and home by six. Just to sink into a chair right now would be luxury.
    But one did not sit during Monday morning attending rounds. Certainly not when the attending was Dr. ColinWettig, Chairman of Bayside Hospital's Surgical Residency Programme. A retired Army general, Dr. Wetrig had a reputation for crisp and merciless questions. Abby was terrified of the General. So were all the other surgical residents.
    Eleven residents now stood in the SICU, forming a semicircle of white coats and green scrub suits. Their gazes were all trained on the residency chairman. They knew that any one of them could be ambushed with a question. To be caught without an answer was to be subjected to a prolonged session of personalized humiliation.
    The group had already rounded on four post-op patients, had discussed treatment plans and prognoses. Now they stood assembled beside SICU Bed 11. Abby's new admission. It was her turn to present the case.
    Though she held a clipboard in her arms, she did not refer to her notes. She presented the case by memory, her gaze focused on the General's unsmiling face.
    "The patient is a thirty-four-year-old Caucasian female, admitted at one this morning via the trauma service after a high-speed head-on collision on Route 90. She was intubated and stabilized in the field, then airlifted here. On arrival to the ER, she had evidence of multiple trauma. There were compound and depressed skull fractures, fractures of the left clavicle and humerus, and severe facial lacerations. On my initial exam, I found her to be a well nourished white female, medium build. She was unresponsive to all stimuli with the exception of some questionable extensor posturing--'
    "Questionable?" asked Dr. Wetfig. "What does that mean? Did she or did she not have extensor posturing?"
    Abby felt her heart hammering. Shit, he was already on her case. She swallowed and explained, "Sometimes the patient's limbs would extend on painful stimuli. Sometimes they wouldn't."
    "How do you interpret that? Using the Glasgow Coma Scale for motor response?"
    "Well. Since a nil response is rated a one, and extensor posturing is a two, I suppose the patient could be considered a... one and a half."
    There was a ripple of uneasy laughter among the circle of residents.
    "There is no such score as a one and a half," said Dr. Wettig.
    "I'm aware of that," said Abby. "But this patient doesn't fit neatly into--'
    "Just continue with your exam," he cut in.
    Abby paused and glanced around at the circle of faces. Had she screwed up already? She couldn't be sure. She took a breath and continued. "Vital signs were blood pressure of ninety over sixty and pulse of a hundred. She was already intubated. She had no spontaneous respirations. Her rate was fully supported by mechanical ventilation at twenty-five breaths per minute."
    "Why was a rate of twenty-five selected?"
    "To keep her hyperventilated."
    "Why?"
    "To lower her blood carbon dioxide. That would minimize brain edema."
    "Go