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  “Alexandria McHenry,” he said, and she winced. He noticed it and asked, “Problem?”

  “I never go by my full name,” she said. “I prefer Alex.”

  “Alright,” Mr. Chase said, completely nonplussed as he scribbled the corrected name onto her index card and then put it down on her desk. “Plant yourself, Alex.”

  She sat down, then looked at her question. What will make you a good EMT? She wanted to laugh—after half the class talked about their medical experience and the loved ones that they cared for at home, she was no longer sure that she was in the right place.

  But everyone was looking at her and waiting, so she read the question out loud and then said, “I’ve been told that I’m good in a crisis. I’m calm on the outside even when I’m panicking inside. I make level-headed decisions most of the time, and people tell me I’m comforting.”

  “Thank you, Alex,” Mr. Chase said, then flipped the next index card down on the desk beside her.

  Chapter Three

  Megan

  A few weeks into her second year of medical school, when October was under way and the smell of burning leaves could be found whenever she went outside, Megan went with her class to the County Medical Examiner’s Office to observe an autopsy. They were in the middle of a pathology module in class and they had been discussing the causes of disease, so Dr. Morrow arranged for a clinical experience that would tie into his lectures.

  Megan had been in a cadaver lab for her human anatomy courses last year, but this was one of her first forays into seeing an actual patient, regardless of whether that person had a pulse. Chloe was so excited for it that she had barely slept the previous night, and this morning Megan found her sitting at the dining table with her pathology textbooks and Gray’s Anatomy, squeezing in a little last-minute studying while she waited for her oatmeal to warm up in the microwave.

  “What do you think the cause of death is going to be?” she had asked as Megan shuffled toward the coffee maker.

  “Mmpfhh,” Megan groaned. She would have been more excited about the field trip if she hadn’t woken up with a pounding migraine that morning, and her only concern at that point had been to caffeinate as a means of counteracting it.

  “Maybe it’ll be a murder,” Chloe said, her eyes lighting up. “Like something on CSI.”

  “Doubtful,” Megan had said.

  “Hey, a girl can dream,” Chloe answered, irritated that Megan wasn’t in the mood to play along with her. She flipped her blonde hair over her shoulder and went into her bedroom to get dressed while Megan propped her hands against the kitchen counter and waited for the coffee to percolate, her head throbbing behind her eyes.

  When it was time to go, Chloe drove and Megan sat in the passenger seat, using the visor mirror to try to make herself presentable. Her red hair was frizzy and she couldn’t be bothered with makeup while her head felt like it was in a vice, but at least her white coat was crisply ironed after Chloe noticed her pain and took pity on her. There were a few benefits to living with a perpetually cheerful, nurturing type.

  Megan’s head was feeling a little better by the time they arrived at the Medical Examiner’s Office, thanks to a large cup of coffee and a couple of Excedrin. She and Chloe went inside and a receptionist greeted them cheerfully, almost as if they were there for a hair appointment, not to look at the inside of a human body.

  The lobby was clean and new—and a tad too bright—and through a nearby door, Megan could see a row of cubicles just like any other office building. The first thing that seemed a little out of place was the security keypad on a door at the back of the lobby, which the receptionist carefully shielded while she punched in her code. The door swung open on an automatic track and the building transitioned abruptly from office to laboratory. There was a long hall with doors along both sides, labeled with words like Toxicology and Histology.

  “The autopsy suite is the last door on the right,” the receptionist said, waving Megan and Chloe into the hall, and then she headed back to her desk.

  They found the right place, a large room with a loading bay at one end and a couple of steel autopsy tables at the other. The majority of their class was already present and accounted for, and Ivy was standing in the only place Megan would expect of her. She was right in front of one of the steel tables, a legal pad in hand, taking notes on every aspect of the autopsy suite that she could see.

  “Ready to test out your bedside manner?” Megan quipped to Ivy as she and Chloe found places near the end of the table. “This is probably the only place where it would be appropriate.”

  “Wow, Megan,” Ivy said, turning her nose up as she looked at her. “So nice of you to arrive looking professional and groomed. I think there’s a spare body bag around here somewhere if you need it.”

  “Be nice to her, she has a migraine,” Chloe chastised, slipping her arm around Megan’s shoulder. She managed to say it without a hint of irritation in her voice. As far as Megan could tell from their interactions in class, Chloe was the only person in the entire program whose head Ivy hadn’t bitten off at least once in the last year. It was kind of remarkable.

  Ivy turned back to her notes and Chloe asked Megan, “Are you feeling okay? Do you need another Excedrin? Some water? A snack?”

  Megan waved her off, thinking that it must be pretty hard to be mean to someone who literally did not kill spiders. In the last year, Megan had come home on three separate occasions to find glasses from the kitchen upended on various surfaces in the apartment, spiders trapped under each of them alongside a note in Chloe’s bubbly handwriting asking her to pretty please take them outside.

  Megan was always tempted to just kill them because it was easier—they lived on the third floor so carrying a hairy, gross spider down three flights of stairs was no picnic—but in the end, she always rescued the stupid things like Chloe wanted. She shrugged herself out of Chloe’s embrace and turned her attention back to the room around her.

  “Look at that enterotome,” Ivy was saying, pointing with her pen at an instrument tray full of sterilized tools.

  Megan rolled her eyes at her while Chloe leaned over and inspected the instrument. It was nothing more than a pair of scissors with a specially curved end to prevent unintentional cuts, but Ivy was showing off, making sure everyone knew she’d done her research, and the Medical Examiner wasn’t even there yet.

  The door to the suite opened again, and this time another large group entered. None of the newcomers were wearing white coats—instead they all wore blue polo shirts with Evanston Community College embroidered over their pockets—and Megan noticed that a few of them looked sort of pale and skittish.

  “Paramedic students,” Chloe said, whispering it to Megan like it was a secret. “I hear they bring them to an autopsy before they go into the field so that if they’re going to pass out or vomit, they do it here instead of during a real case.”

  “Megan might beat them to it,” Ivy said, but she at least had the presence of mind to murmur this latest insult—she’d meant it to be harmful to Megan, not to the EMT students.

  “I’m fine,” Megan said with a wave of irritation. She wondered just how long she would have to put up with Ivy’s dominant, aggressive posturing. Last year she’d harbored the hope that once exam time came around and Megan had a chance to trounce her, Ivy would lay off, but the fact that Megan was ranked higher in the class by the end of their first year only served to spur Ivy’s insults on.

  Megan watched the EMTs come into the room. They were looking all around and noticing the mortuary refrigerators along one wall. A few of them seemed to be actively avoiding them, looking anywhere but the refrigerators and the autopsy table, and Megan wondered which one of them would be the first to hit the floor when the autopsy got started.

  A couple of them were chattering nervously and Megan listened in on their conversation because it was either that or continue to listen to Ivy’s impromptu lesson on autopsy instrumentation.

  “We’re not,
like, all going to end up here, are we?” one of them, a chubby blonde, asked. She was staring at the ambulance bay on the far wall as if she were looking into her own morbid future.

  “No,” said the girl standing next to her. “The Medical Examiner doesn’t handle natural deaths, so most people don’t get autopsied when they die.”

  Megan found herself drawn into their conversation. The blonde looked uncomfortable in this sterile, slightly ominous setting, but the second girl had an air of stoicism about her that was intriguing to Megan.

  She didn’t seem to fit with the rest of the group, and she most certainly didn’t look like the type of person that made a successful paramedic. She was tall, thin but not too skinny, with long, chestnut-colored hair, a button nose, and a youthful face. Megan guessed her to be eighteen or nineteen, not far out of high school. She didn’t look like the type of person who could handle the responsibilities of being a paramedic—Megan wondered how she’d ever lift a fallen patient, or ride in the back of an ambulance without her small frame being thrown around at every turn. Then again, a lot of people surprised Megan ever since she started medical school—she never would have dreamed that someone as tiny and cute as Ivy could contain so much ire.

  Realizing that she’d been staring at the paramedic and her friend for far too long, and that their conversation had moved on from autopsies to study sessions, Megan turned away and tuned back in to Ivy’s mini-lecture.

  “A lot of people don’t realize that not everything you find in an operating room, or an autopsy room as the case may be, is actually manufactured as a surgical instrument,” she was saying. “Kitchen shears, for instance, when sterilized properly…”

  Megan’s headache had turned from sharp and nauseating to dull and throbbing but still persistent, and the room was beginning to heat up with all of the people standing around her. She felt herself growing impatient and wondering where the Medical Examiner was. She just wanted to get this field trip over with so she could go home and crawl back into bed until her headache was nothing but a distant memory.

  Chapter Four

  Alex

  The week leading up to the field trip to the Medical Examiner’s Office had been characterized by a lot of nervous energy in Alex’s class. Watching an autopsy was something that everyone in the paramedic program at Evanston Community College did—a rite of passage and also a bit of preparation for the worst type of emergency they would be responding to on the job.

  Most of Alex’s classmates spent the week wondering what their reaction to seeing a dead body would be. Poor Sarah looked white as a sheet that morning when they met in the Medical Examiner’s Office parking lot.

  “I want to help living people,” she said. “I don’t understand how this is relevant or necessary.”

  “People die sometimes,” Alex said.

  For all the nerves she felt over the prospect of working as a paramedic, this particular day didn’t bother Alex at all. This was not the first time that Alex would see a dead body. She wasn’t worried about passing out, or vomiting, or being unable to handle the sight. The only thing Alex was worried about was the possibility that she might burst into tears and be unable to stop.

  Just over a year ago, her father died and she still hadn’t cried about it.

  The Medical Examiner wasn’t there yet by the time the rest of her class—along with Mr. Chase—arrived and they all went into the autopsy suite, and Alex passed the time by walking slowly around the space, examining the laboratory. She reassured Sarah that not everyone ends up here, and that was true. Thankfully, Alex’s father had never laid on an autopsy table or else Alex didn’t think she could stand being there.

  It was a heart attack, one of the most clear-cut natural deaths a person could have. He was in the kitchen dicing vegetables for dinner and she was sitting on the couch in the living room, using her laptop to register for her sophomore classes at the University of Illinois. Her mom wasn’t home from work yet and she was calling back and forth to her dad, planning what to get for her mom’s birthday. Then she heard a loud metallic clatter as her father dropped the knife he was using.

  “Shit,” he muttered, and she half-rose out of her seat to check on him, asking what happened, but he said, “I don’t know. Butter fingers, I guess.”

  He didn’t sound concerned. Alex sat back down, trying to focus on her schedule again, but an unsettled feeling was growing in her stomach. Something wasn’t right. A minute later she heard something else fall, much heavier this time, and she flew into the kitchen to find her father on the floor, slumped against the cabinets.

  “I’m having a dizzy spell,” he said, looking at her with confusion. He had his hand on his chest, and Alex felt her pulse beginning to race. She froze in the doorway, trying to make sense of the scene. He was dizzy—what do you do for dizziness? She thought about telling him to put his head between his knees, but then his eyelids fluttered shut and that was what finally pushed her into action again. She grabbed his phone off the counter and dialed 911, dropping to her knees beside him while she waited impatiently for the operator to tell her what to do.

  The operator talked her through a rudimentary form of CPR, and eventually the sirens of an ambulance blotted out all the other sounds in Alex’s world. Paramedics rushed into the kitchen and took over, and Alex just kept thinking that dinner would be ruined if she didn’t remember to put the meat back in the refrigerator before they went to the hospital. It couldn’t sit on the counter or they would have nothing to eat later.

  No one ate that meal, though. The world came crashing to a halt that night for Alex and her mother, and the vegetables her father was chopping sat on the counter for days before Alex got up the courage to throw them away.

  Then for a long time life stood still, until one day last month Alex enrolled in EMT school. The paramedics that responded to her father’s emergency were so fast and so good at their jobs, and they even found the time to be comforting to Alex. She never wanted to feel that helpless again. She wanted to be like those paramedics instead.

  She led Sarah over to the autopsy table, standing behind a row of what must be medical students, all in white coats. Alex steeled herself, determined to get through this field trip without breaking down. She was a blank slate ready to learn from this observation and completely divorce it from her real-life experiences.

  When the Medical Examiner finally arrived, trailed by two assistants in surgical scrubs, the conversation in the room trailed off. The Medical Examiner stood near the front of the room and addressed everyone, introducing himself as Dr. Markovich, but hardly anyone was actually looking at him. Behind him, his assistants were opening one of the mortuary refrigerators, and all eyes—Alex’s included—were glued to them.

  The door yielded a few wisps of condensation, nothing like the dramatic cloud of chilled air that forensic television shows trained Alex to expect, and then the assistants pulled out a long steel rack on top of which lay the body. Alex felt Sarah slip her hand into her palm, squeezing it tight, and one of the assistants retrieved a gurney that had been pushed up against a nearby wall.

  “The decedent has arrived with us by way of the Emergency Room,” Dr. Markovich was saying. “He is a fifty-four-year-old male who was found in the midst of a grand mal seizure in his office two days ago. By the time the paramedics arrived, he had become unresponsive and despite efforts to resuscitate, he was dead shortly after arrival in the ER. There was no past history of seizures.”

  Alex watched as the two assistants lifted the body—the decedent—onto the gurney and she had a sudden, overwhelming urge to raise her hand.

  Dr. Markovich looked rather perturbed by her interruption, but he nodded at her. “Yes?”

  “What was his name?” Alex asked, glancing at Mr. Chase to gauge how out of line this question was. She didn’t think she could watch an autopsy without knowing anything about this person except his age and the circumstances surrounding his death. Judging by the critical looks she was getting fro
m some of the medical students, the medically relevant information the Medical Examiner provided was all they needed.

  Dr. Markovich had to look down at the tablet in his hand, consulting an electronic chart, but he did answer her question.

  “Paul Goulding,” he said, and then without waiting for any further remarks from the audience, he went on. “Since Mr. Goulding was an otherwise healthy man and the cause of his seizure and subsequent death is unknown, we are now going to see what the body can tell us about the cause of death.”

  The two assistants wheeled the gurney over to the table where everyone was gathered, and the difference between the two groups of observers became obvious. Everyone in a white coat leaned in, fighting for a place closest to the table, and everyone in an Evanston Community College polo took a step back.

  “What do you think it is?” one of the medical students, a pretty Asian girl, whispered to her classmates. “I’m thinking status epilepticus.”

  Status what now? Alex thought, wondering just how far outside her comfort zone she had put herself. The other medical students threw in their two cents with other potential diagnoses while Alex’s class just watched in silence.

  Sarah squeezed her hand again as the assistants put the body down on the table. Alex wasn’t too easy to rattle, but she did jump a little at the way they did it with such efficiency. She couldn’t blame the assistants—they’d probably done this so many times that they didn’t even have to think about it anymore, and with the nature of their work it was almost certainly necessary to create a little space between themselves and the decedents. Still, it was so… mechanical.

  Paul Goulding, she thought as they took the gurney away and Dr. Markovich stepped up to the table.

  “If anyone is feeling queasy at any point during the autopsy, there’s a bench just outside the ambulance bay where you can get some fresh air. Please resist the urge to vomit in the autopsy suite,” he cautioned with a tired expression, as if he was reciting this message for the hundredth time. “There’s always one.”