Chapter 1 - What Was Under the Cast

I had spent eight years learning that emergency medicine rarely gave you the luxury of solving one problem at a time. Sometimes you had to make the decision that kept a patient alive first and deal with everything else after.

That night, the decision was simple.

I looked Mrs. Moretti directly in the eyes. “Whatever happens after I remove this cast, we’ll handle it. But if I leave it on, your son may not survive long enough for any of those consequences to matter.”

Her grip loosened around my wrist.

For a moment she looked as though she might argue again. Then her shoulders collapsed.

“Do it.”

Marcus was already moving. We started broad-spectrum antibiotics, drew cultures, pushed fluids, and called orthopedics and vascular surgery. A nurse brought the cast saw while another attached additional monitors.

The boy’s name was Leo.

His blood pressure continued falling.

I started cutting.

The smell became unbearable almost immediately.

One nurse turned her face away.

Marcus whispered something under his breath.

Mrs. Moretti closed her eyes.

The cast separated near Leo’s wrist. I carefully pulled one side outward, expecting infected skin, pressure damage, maybe a neglected wound that had become necrotic.

What I saw was worse.

Leo’s forearm was swollen nearly twice its normal size. Several areas of skin had turned gray-black, and an infected wound near his wrist was leaking through layers of old gauze.

But that wasn’t what made Mrs. Moretti begin crying.

It was the marks farther up his arm.

Bruises.

Not one.

Several.

Some yellow and fading. Others dark purple.

And around his upper arm were narrow parallel marks that looked nothing like injuries from falling out of a tree.

Marcus stared at them.

“So the fracture…”

“Wasn’t from a tree,” Mrs. Moretti whispered.

Before I could ask anything else, the trauma-room door opened.

The man standing there didn’t need an introduction.

Vincent Moretti was probably in his late forties, tall, broad-shouldered, dressed in a charcoal suit that looked expensive enough to pay several months of my mortgage. Two men remained behind him, but Vincent entered alone.

His eyes went immediately to his son.

Then to the exposed arm.

He stopped.

The entire room seemed to change.

“What happened to him?”

Mrs. Moretti backed against the wall.

“Vincent—”

“What happened to my son?”

His voice never rose.

That somehow made it worse.

I stepped between him and the bed. “Mr. Moretti, your son is critically ill. Whatever conversation needs to happen can wait until we stabilize him.”

He looked at me as if people rarely interrupted him.

“Will he live?”

“I don’t know yet.”

That answer hit him.

Not visibly at first. His expression remained almost perfectly still, but his eyes returned to Leo’s face and something inside them broke.

He approached the bed.

I expected questions about the bruises.

Instead, Vincent reached down and gently touched his son’s hair.

“Hey, champ.”

Leo didn’t respond.

Vincent swallowed.

Then he noticed the wound.

His hand froze.

“What is that?”

Mrs. Moretti began shaking.

Vincent looked at her.

“Isabella.”

She stared at the floor.

“Tell me.”

“He didn’t fall from a tree.”

The monitor beside Leo suddenly began alarming.

His blood pressure had dropped again.

“Everybody out,” I ordered.

Vincent didn’t move.

“Now.”

One of his men stepped forward, but Vincent raised a hand and stopped him. Then he looked at me.

“Save my son.”

“We’re trying.”

He turned toward Isabella.

“You’re coming with me.”

“No,” I said.

Vincent slowly faced me.

“Excuse me?”

“She stays.”

His expression hardened.

“She knows what happened to Leo, and until I understand whether this child has been deliberately harmed, nobody who may have information about his injuries is disappearing into a private conversation.”

Marcus stared at me as though I had temporarily forgotten who I was speaking to.

Maybe I had.

Or maybe I simply remembered who mattered most in that room.

Leo.

Vincent looked at me for several long seconds.

Then, surprisingly, he nodded.

“All right.”

Security moved the Moretti entourage into a consultation room while we rushed Leo toward surgery.

The infection had spread deeper than I feared. Orthopedics suspected osteomyelitis. Vascular surgery worried that prolonged swelling beneath the cast had compromised circulation badly enough that Leo might lose part of his arm.

As the elevator doors closed, Isabella caught my sleeve.

“There’s something else.”

I looked at her.

She was crying openly now.

“The person who hurt Leo is in this hospital.”

My stomach tightened.

“Who?”

She looked through the glass toward the three men who had arrived with her son.

Then she whispered a name.

“Anthony.”

I remembered the man who had first opened the trauma-room door.

The man who announced Vincent’s arrival.

Isabella’s voice dropped even lower.

“He’s Vincent’s brother.”