“A pioneering work . . . Kinder’s book sparks reflection. And almost screams for more such books, many more.” —Los Angeles Times Book Review

“Just as Capote did, Kinder has somehow created a story that is truer than true.” —The Atlanta Journal-Constitution

Then he flipped a switch, lighting a large red flasher on the switchboard upstairs. Immediately, “ER alert” reverberated over the hospital intercom. Far below, in the middle of town, the flashing red lights of the ambulance began whirling silently in the night.

The glass doors to the emergency room were propped open, and the two doctors were joined in the hallway by nurses from Intensive Care and Coronary Care, a medical technician, a respiratory technician, an X-ray technician, and the nursing supervisor. They waited by the open doors for an ambulance they were certain carried two bodies from Ogden’s notorious Twenty-fifth Street. Winos from the street were rushed to the hospital regularly to have their heads sewn up or a knife wound closed or to be pronounced DO A from one cause or another. Someone standing by the door said that this time one of them had probably shot his old lady then turned the gun on himself. Each of the crew feared only that he or she would be assigned to peel off the shoes or the socks or the underwear of one of the victims.

As the crew waited by the ER doors, the ambulance zigzagged through the grid of city blocks, moving steadily toward the hospital. Traffic was light, and the few cars on the streets cleared away at the sound of the approaching sirens. The motorcycle escort passed first; then a hundred yards behind it came the ambulance at a steady fifty miles an hour. Eight blocks from town they swung right onto Harrison, sped up for a few blocks, then braked and swung left at the high school. Behind the motorcycle the ambulance driver shot straight up the hill, turned right, shut down the siren, and raced the last two blocks to the neon orange EMERGENCY.

The ambulance circled beneath the red brick portico, its flashing red light ricocheting off the walls, splashing over the waiting crew like an eerie red strobe. They saw the driver spring from the front seat. But he moved without that controlled sort of quickness the ambulance attendants usually exhibited. He was shouting, but no one could understand him. He sprinted to the rear of the ambulance and flung open the doors. Two attendants kneeling in back were frantically trying to squeeze oxygen into the victims. They looked frightened. The crew realized then what they had only sensed watching the driver. Something had gone awry.

Then suddenly all three of the attendants were yelling to them at once. Disjointed bits and pieces of torture and mass murder. Of a girl raped. Of a man strangled. Of a ball-point pen driven into a victim’s ear. Of five people bound on their hands and knees and shot through the head, blood and vomit everywhere, the most sickening thing any of them had ever seen. They shouted that there were still more bodies in the basement of the Ogden Hi-Fi Shop.The attendants shoved the stretchers out of the ambulance, and the emergency crew moved in quickly to help. Hands reached out and lowered the bodies into the wash of red light.

On the first stretcher, in a red dress, was a petite blond woman, a large diamond ring on her left hand, an ornate jade ring on her right. Behind her was a teen-age boy dressed in jeans and a brown-check shirt, his longish blond hair cut in a neat shag. He was gulping for air like a dying fish. His skin was bright blue, his blond hair spattered with blood and flecks of vomit. From his mouth bright red scars trailed away across his cheeks and chin. The woman’s hair was soaked with sweat, making her appear almost bald. In the back of her head, her blond hair was matted around a bloody hole, and the same curious red scars encircled her mouth. Both bodies stank of blood and vomit.

The group that not sixty seconds earlier had dreaded only gummed socks and stained underwear were now staring at two bodies, not from the remote gutters of Twenty-fifth Street, but from their own safe world.

The confusion spilled through the doorway and hurtled twenty feet down the corridor to the trauma room. Dr. Wallace ran alongside. For an instant he thought the woman looked familiar. He yelled to the driver.

“Any idea who they are?”

“No!” the driver yelled back.

“What about these scars around the mouth?”

The driver hadn’t even noticed them.

“I don’t know,” he said.

An attendant kept pace with the boy, trying to squeeze oxygen from a black Ambu bag into the boy’s lungs. Wallace grabbed his arm.

“Hold off for a minute,” he said. “Let’s see what we’ve got here, first.”

Wallace ran ahead to the trauma room, turned around, and stared in disbelief at the bodies coming through the door.

“For Christ’s sake, since when do you bring them in here backwards!” he yelled. “Get them turned around so we can work on them!”

He scanned the bodies quickly with his eyes. The boy was trying to breathe, but the woman made only an occasional effort. Wallace began shouting orders.

“Jim, see what you can do for the woman. Chad, you go with Jim. Get a tube in her as fast as you can. Andy, you and Vicky stay with me. Ginny, shoot two pictures of each, the woman first.”

Dr. Allred and respiratory technician Chad Nielsen wheeled the woman across the hall to the other room. In the trauma room, nurse Vicky Moyes yanked the curtain closed. The boy’s body was swung in a sheet hammock from the ambulance cart onto the trauma table. Vicky scissored off the boy’s shirt and removed his pants.

From the time Wallace’s eyes made contact with the boy’s body, he had been reflexively cataloging his injuries and life signs: bullet hole right rear of head; body flaccid, bright blue; red scars around mouth–no explanation. The boy’s body now lay naked and unconscious on the table. Wallace began a closer, rapid examination. The boy’s pupils were dilated and gave no response to light. His heart was palpitating wildly. His lungs were barely expanding. There was a tight gurgling in his chest. A peculiar odor emanated from his mouth. Dr. Wallace gripped the boy’s sensitive Achilles tendon and mashed it between his fingers. The boy did not even flinch.

Wallace looked at the youthful face now gray and gasping for air. “Okay, we’ve got to try something,” he said. “Vicky, start an IV, see if you can get him some blood pressure. Andy, hand me the laryngoscope, and have the tube ready.”

He stood behind the boy’s head. Andy Tolsma, the medical technician, grabbed a long, thin chrome cylinder from the crash cart and slapped it into his outstretched hand. Wallace held the boy’s chin with one hand, pulling it back to form a straight line from the boy’s mouth to his trachea. With the pinpoint of light shining from the laryngoscope, he searched the boy’s throat for the white-ringed vocal chords.

“Andy, get the tube ready . . .” He stopped. “Wait a minute, wait a minute. His throat’s so swollen I can’t even see the damn vocal chords!”

Wallace dropped the laryngoscope. He snatched the plastic tube out of Andy’s hand and stuck one end in the boy’s mouth. He placed his ear over the other end of the tube and listened for air exchanges. Quickly, smoothly, he manipulated the endotracheal tube through a mass of swollen tissue and farther down the boy’s throat. At last it pushed past a triangular flap of skin and slid into the trachea.

Standing up quickly, he said to Andy, “Hook up the bag and start pumping him.”

Andy attached a quart-size black bag to the mouth of the tube. A machine filled the bag with oxygen. Andy hand-squeezed the oxygen into the boy’s lungs.

The nurse was struggling with a needle in the boy’s arm. Dr. Wallace stepped around the table.

“What’s wrong, Vicky?”

“His veins have collapsed.”

“Let me try it. You get the bottle ready.”

Wallace gripped the boy’s arm and pressed the needle deep into the flesh. It hit the vein on the first try. Vicky stepped in and attached the tube to a hanging bottle of dextrose. Wallace looked up.

“What the hell is that?”

He stared at the plastic valves of the bag Andy was squeezing. Oozing from the boy’s throat was a bloody, pink froth. Wallace could see no explanation for this pulmonary edema unless the boy, in addition to being shot, had also swallowed some sort of caustic.

“Vicky, see if you can suction that stuff out. Andy, you better set up for a trache. Keep pumping and suctioning him. I’ve got to take a look at the woman.”

Across the hall Dr. Allred had also inserted an endotracheal tube in the woman. Chad was bagging her with a similar black oxygen squeeze bag. Ginny Tolsma was trying to X-ray the woman’s head when Dr. Wallace hurried in.

“Hon,” he said to her, “you’re going to have to move a little faster. You’ve got to finish the woman and do the boy real quick. I might have to do a trache on him. We need those pictures right away.”

Ginny nervously realigned a photographic plate beneath the woman’s head and maneuvered the bulky machine in closer. She snapped the picture, removed the plate, held another plate to the side of the woman’s head, and snapped a second picture. Then she stepped back out of the way and dragged the X-ray machine across the hall.

The two doctors were already examining the woman. She was splotched with blood and vomit. Her breathing was sporadic and only shallow when drawn. Her heart had stopped beating. Her blood pressure was zero.

Wallace said, “Nothing much to save, is there.”

“Jess, she doesn’t have a chance,” said Allred. “I don’t even know why we’re supporting her.”

“I know she’s not responding, but I want Hauser to take a look at her before we stop bagging her.” He stared at the woman’s face. “Boy, she looks familiar.”

Dr. James Hauser, the neurosurgeon called in by Dr. Wallace at the time of the alert, appeared in the room and ducked inside the curtain.

“We don’t think the woman’s got a chance,” said Wallace. “Take a quick look at her, then you’ve got to hurry across the hall and examine the boy.”

Dr. Hauser felt the woman’s skin, which was cool and clammy. With thumb and forefinger he spread her eyelids and shined a light into her pupils, which were large and unresponsive.

“This doesn’t look good at all,” he said. “How long has she been here?”

“Not more than four or five minutes,” said Wallace.

“What’s her blood pressure?”

“I can’t get a reading,” said Allred.

Dr. Hauser was meticulous but quick with his examination. As he was finishing, Ginny Tolsma brought in the developed X rays. The woman’s shadowy skull was marked by two bright metallic spots. The bullet had entered her brain just above her right ear and split in two. One piece of the missile had traveled forward. The other had veered down toward the brain stem. The three doctors only glanced at the X rays.

“I think you should quit,” Dr. Hauser said to Chad. “There’s nothing more we can do for her.”

Chad stopped squeezing the black bag, and the woman made no further attempt to breathe.

Dr. Wallace and Dr. Hauser ran across the hall. Andy was squeezing oxygen into the boy’s lungs. At intervals he removed the black bag and Vicky ran a thin, slurping tube down the boy’s plastic airway. She was trying to suction out the bubbles. But the bubbles flooded into the airway, faster and faster, redder and redder. Like a machine his lungs were manufacturing copious amounts of reddish foam. It skirted the suction tube, boiled over, and spread across the boy’s face. As Dr. Wallace ran into the room, he focused immediately on the boiling pink liquid.

“That stuff won’t suction out any faster?”

“No,” said Vicky, “and it’s getting worse.”

Wallace looked quickly at the boy’s eyes and thought he saw a slight reaction in the pupils. To Hauser they appeared fixed and dilated.

“Go ahead and take a closer look at him, anyhow,” said Wallace, “while I do the trache.”

The boy’s blood pressure was still zero. His skin was blue and clammy. He was making a hacking attempt to breathe. His left arm had risen from the table slightly, his hand turned to the outside and flexed open. Stiff-armed, it clawed the air.

The blood spurting from the boy’s endotracheal tube had begun to splatter, and Andy was hurriedly tying a gown around Wallace as the doctor prepared to open the boy’s throat.

“Jess, there’s nothing you can do for this boy,” Hauser said. “I don’t give him more than a few minutes.”

“Well, he’s not going to die in my emergency room,” said Wallace.

“This decerebrate posturing with the hand,” continued the neurosurgeon, “and the fixed pupils with this kind of head injury . . . I have never in my life seen this situation in a patient who survived.”

Wallace had children of his own not much younger than the boy. When the boy’s body had been pulled from the ambulance, Wallace had been struck first by his youth, then by his gasping for air.

“Maybe so,” he said to Hauser, “but the kid’s still trying to breathe, and we’re going to put this trache in and see if we can get him some air. I can’t just sit here and watch him die.”

“It’s your emergency room,” said Hauser, “you do what you want. But I’m advising against any heroics.”

Andy had prepared the Mayo stand with the tools for the tracheotomy. Wallace took a scalpel from the tray and neatly sliced the boy’s throat at the base of his neck. Andy pulled the skin back with hemostats to expose the underlying tissue. Vicky bagged and suctioned the boy through the tube still in his mouth. Dr. Wallace’s thick forearms were upraised, his eyes riveted on the slit in the boy’s throat. He carefully cut away at the tissue surrounding the trachea. Andy spread the incision wider. The boy’s gristly tracheal cartilage emerged. Andy wrenched a hook into it, twisted it slightly, and held it firm as Dr. Wallace cut a dime-size hole in it. Andy spread the cartilage. Wallace reached for the new five-inch plastic tube. As Andy yanked the endotracheal tube from the boy’s mouth, Wallace inserted the tracheostomy tube through the cartilage in his throat. Vicky fastened it with cotton ties, reattached the squeeze bag to the new tube, and continued bagging and suctioning the boy. A delicate operation that usually requires fifteen minutes had taken a little under three, and there were no bleeders to tie off. Andy attached a humidifier to the oxygen bag to warm and moisten air for the boy’s lungs, while Vicky tried to suction the bubbles flushing out of the new tracheostomy tube.

As soon as he had examined the boy, Dr. Hauser had been paged by the hospital switchboard for another emergency at the McKay-Dee Hospital. Before he left the trauma room, he took up the boy’s chart and under Physician’s Notes hurriedly wrote the following entry:

Young white male with gunshot wound of R occipit–has had trache thru which there are copious, pink, frothy secretions. Breathing vigorously but totally unresponsive. Pupils dilated & fixed. Impression: terminal head injury.

Intensive Care had been alerted to prepare for the boy. With his tracheostomy tube now in place he was immediately rushed from the trauma room, down the hall, into the elevator, and up to Intensive Care on the third floor. The IV dangled from his arm as a nurse ran alongside the cart holding the bottle of dextrose. Vicky jogged on the other side, squeezing oxygen into the foam filling his new airway.

Dr. Wallace untied the gown from around his waist and watched the crowd attending to the boy.

“Andy,” he said, without turning around, “we’re sending that boy up there and he’s just going to die.” He wadded the bloodstained gown in his fist and threw it into a corner. “What the hell,” he said, “Maybe Hauser was right.”

The cart and the nurses rounded the corner at the end of the hall and disappeared. For a few more seconds Dr. Wallace stared after them. “The whole thing was unreal,” he said later, “because I was looking at two people, one who was dead and one who was critically injured for no reason at all. You know, you see people hit in cars and even though it’s hard to justify, you can see how it happens. You see a child run into the street and he’s hit and killed, it’s disturbing and upsetting. There’s a certain aspect of Russian roulette to living. But just for somebody deliberately to set out and try, actually try, to kill these people . . . you couldn’t understand how anybody’s mind could be so depraved. That’s what was so unreal about it, to sit there and look and see the straits this kid was in and know that somebody had done it with no more feeling than if they’d crushed a bug.”

He turned back and said to Frances Heward, the nursing supervisor, “Fran, why don’t you and Andy take the woman on over to the morgue; we’ll need to keep her body preserved for the medical examiner.”

It had been almost a half hour since the unusual gunshot victims had arrived. Their identities still were unknown. The body of the petite blond-haired woman, listed as Mary Doe, was slipped into the top refrigeration unit in St. Benedict’s tiny morgue. Upstairs, in Intensive Care, the teen-age John Doe was spewing blood from his lungs nearly three feet into the air.

No one expected him to live. Even Dr. Wallace, when he sent the boy up to ICU, had listed him as a “no-code,” meaning that if the boy’s breathing stopped or his heart quit beating, no life-saving measures were to be taken. If the boy’s brain shut down to where it no longer was capable of the primitive function of asking for oxygen, there was nothing left of him to save anyhow.

His body remained on the gurney, not enough life in it to warrant transfer to a more permanent bed. They wheeled the gurney into ICU and straight ahead into unit #1, a cubicle with a broad glass front. The boy lay behind the glass, appearing to be a man, much older. His body was motded gray and white. His cheeks were sunken, and his eyes were dark and hollow-looking. His fingernails were blue-gray. The bloody foam gathered in his lungs, inched its way up the tube in his throat, rising and rising, until his gasping attempt to get oxygen would explode the foam like a small, pink geyser out the end of the tube. The watery pink foam splattered on the nurses and the technicians, until even the walls of the small room were stained with splashes of pink.

Chad Nielsen and John Smith, the respiratory technicians, set up a small pressure ventilator in the cubicle. Dr. Hauser also had left instructions for them to do nothing life-saving.

“Suction him if you want to,” he had said, “but if he stops breathing, don’t resuscitate him. I don’t want you pumping air into a body that’s not asking for it.”

They dialed the ventilator to Demand, so that it pumped air into the boy’s lungs, but only if he initiated each breath. Since the bubbles to be suctioned out would pop and merely reform around the suction tube, they nebulized ethyl alcohol and sprayed the mist into the boy’s trache. The mist was designed to break down the surface tension of the bubbles, reducing them to a liquid which then could be easily suctioned out.

As they were spraying the alcohol mist down the boy’s airway, John saw two police officers walk into the ICU and stand next to the nurses’ desk. He handed the suction tube to Chad and walked out of the cubicle to where the officers were standing. They were still calling the boy John Doe.

“You haven’t identified these people yet?” said John.

One of the officers said no, and John said that maybe he could help them eliminate some possibilities.

“A friend of mine in this respiratory therapy program is studying downstairs,” he said. “He used to date a girl whose cousin owns the Hi-Fi Shop.”

The police knew only that the bodies had been found in the basement of the popular stereo store in downtown Ogden; as yet they had no leads on the victims’ identification. They asked John to have his friend come up and take a look at the boy.

John stepped behind the desk and phoned Ray Moser.

“Ray, the police are up here in ICU. I told them about you dating Claire. They want you to come up and take a look at this boy.”

“I don’t think I’d be much help,” said Ray. “I was standing in the hall when you guys wheeled them by and I didn’t recognize either one of them.”

“Come on up anyway and tell them yourself,” said John. “They’re just trying to eliminate possibilities.”

Ray left his studies and ran up the stairs to the third floor. He entered Intensive Care, and through the broad plate-glass window he saw John and Chad nebulizing alcohol into the boy’s airway. The police stood just to the right of the entrance. Ray glanced at them and walked into the cubicle.

Dr. Wallace had treated a few more patients, then left Dr. Allred in charge of the emergency room. He hurried upstairs to see if the boy was still alive. As he walked in the door, Ray Moser was sliding in among John, Chad, and a covey of nurses to take a look at the boy. Wallace waited by the entrance with the officers. Ray was inside for only a few seconds. When he stepped out again, the casual expression on his face had turned to disbelief.

“It’s Cortney,” he mumbled, “Cortney Naisbitt.”

Wallace was incredulous. “You mean By Naisbitt’s boy?”

“Yes, sir. I used to date his sister, Claire.”

“Are you sure?”

“Yeah, I saw him go by a few minutes ago and I just thought, ‘Well, whoever he is, he won’t make it.’ But that’s Cortney.”

One of the officers pulled a small note pad from his pocket and jotted down the victim’s name. “Would you mind going downstairs with us to take a look at the woman?”

“No,” said Ray, “course not.”

Dr. Wallace had already rushed into the cubicle. John and Chad were still spraying a fine mist of ethyl alcohol into the boy’s airway, but the alcohol was being overpowered by the edema. The bloody foam gurgled out of the boy’s lungs, surged through the mist, and poured into the lines of the ventilator.

Wallace saw the pink froth oozing up the tubes. “What the hell are you doing!” he yelled. “He’s trying to breathe! Can’t you clear that stuff out?”

“Dr. Hauser told us just to maintain,” said John, “not to do anything but nebulize him and suction out what we could.”

“I’ll be damned! We’re not going to sit here and watch the kid die!”

“You want us to shoot straight alcohol down the tube?”

“Anything!” said Wallace. “Just get him more air with that ventilator. I’m going to call Rees, then see if I can get hold of Hauser again. If this kid has hung in here this long, he might have a chance.”

Chad and John began a rapid-fire routine. John squirted 20 cc of ethyl alcohol down the boy’s airway. Chad capped the ventilator hose back over the mouth of the tube. The alcohol worked on the bubbles. Chad removed the ventilator hose. John suctioned out a small amount of the fluid. Then they started over again.

While the effort to break up the boy’s edema continued in the cubicle, Dr. Wallace phoned Dr. Richard Rees, a thoracic surgeon skilled in the use of complicated life-support systems.

“Dick? Jess Wallace. Look, I’ve got By Naisbitt’s boy in ICU. He’s been shot in the head, his lungs are full, he may have suffered actual brain death. But he’s still alive. I stuck a tube in the kid. I need you to help resuscitate him.”

Next he called Dr. Hauser’s home, but Hauser had not yet returned from the emergency at McKay-Dee. Wallace left a message with Hauser’s wife.

“Tell Jim the kid he looked at before is still alive and trying to breathe. Rees is on his way, and I’d like Jim to come back and take another look at him too. And tell him we just found out it’s By Naisbitt’s boy.”

A quick call to the home of Byron Naisbitt was not answered. As Wallace hung up the phone, the nursing supervisor walked into ICU.

“Fran,” said Wallace, “that kid in there is By Naisbitt’s boy!”

“You’re kidding,” she said, “it can’t be.”

“A friend just identified him. I’ve tried to get in touch with By, but he’s not home. See if you can get hold of his brother Paul, or any of the rest of the family. I don’t know what the hell’s going on, but somebody ought to be down here with this kid!”