Chapter One
Low-Yield
Two men down. One ambulance. And ninety seconds to decide who gets it. While Oliver does the math no medic should ever have to do, the chapter rewinds to the standoff that put them there -a man who believed the system had already flagged him as not worth saving, and the one warning he presses into Oliver's hands before the door comes down.
Lying on the carpet to his left was a man who had just done the unthinkable. Two feet to his right — a cop. People think that in moments like these that everything slows down, but they're wrong. It doesn't. Everything speeds up, collapses in on itself, and is over before your brain can process what has just happened.
The room Oliver Adams was standing in was still ringing with the aftershock of the point-blank gunshot, his pulse jackhammered in his ears while everyone moved around him like a video being played back at double speed. Voices were stacked on voices, boots scraped on the floor, and someone shouted his name from what sounded like from very far away.
The man to his left had just took a bullet to the head, Oliver could witness that truth from across the room and all over the walls. The man to his right, a Denver cop, had what sounded like a sucking chest wound, and was still writhing on the floor. Both men were someone's son. Both had once got cake on their face and blew out birthday candles while their families smiled and sang.
Oliver moved to the man on his left first.
Not because he thought he was saveable, but because after sixteen years as a Paramedic for the City and County of Denver he'd learned that assuming and confirming were two very different things, and that the one second that it took to press two fingers into a neck was sometimes the only thing that stood between a good triage decision and a mistake that he'd carry forever.
The man had a pulse. It may have been thready, and weak, and wrong, but it was there. Which meant his heart was still beating.
Shit.
"Hollis?"
"Are you kidding me?"
"Nope."
Oliver lifted the man's chin and performed a quick primary assessment, running through the ABC's. He was moving air through his airway, A. He was breathing, B. And he had a pulse, C.
The wound from the bullet above his ear was stained dark from the soot of the gunpowder. His breathing was shallow and rattled, but, like his pulse, it was there. Oliver didn't need a CT scanner to know what the bullet had done on the inside. But his chest was still rising and falling, which meant his heart was still moving blood somewhere.
Travis Rawlins's body was fighting stupidly and stubbornly.
Then his right hand moved. It wasn't voluntary, Oliver knew that. It was the kind of motor response that falsely meant everything to a family and nothing to a neurologist. His fingers curled slowly against the carpet like they were trying to grip something that wasn't there. Oliver watched all of this for exactly one second.
A radio crackled on the shoulder of Oliver's partner, Paramedic Scott Hollis.
Oliver looked up at Scott.
Scott's eyes met his, "That's our backup."
The chaos in the room didn't diminish, the blood on the walls didn't dry, and the two men on the floor didn't get up. This was the scenario that Oliver found himself in: there was now only one ambulance, his two patients were both technically still alive, and he and Scott could only really work on one patient at a time.
He looked at Rawlins on the floor to his left, then glanced over his shoulder at the cop on his right who was panting through gritted teeth with pink foam gathering at the corner of his mouth. He quickly did the math that paramedics do on mass-casualty calls like these and decided which patient would benefit the most from the two sets of experienced hands in the room.
The math here was simple. It was also the worst math Oliver had ever had to do, because in this equation, both answers were wrong, and the only variable that he couldn't control was time. He could still hear Rawlins's voice through a hollow-core door echoing in his mind.
You don't practice medicine. You measure risk and call it care.
Another cop's voice cut across the room like a blade.
"Adams!"
Oliver didn't move. The bad guy's chest rose, then fell, then rose again as blood leaked out of the side of his head. Oliver looked at the seeping wound tracking across the cop's chest and made his decision. Paramedics don't let cops die.
He focused his attention on Denver Police Lieutenant Chris Gibbs and didn't ask permission from the part of his brain that would later question his decision. This was triage medicine down to its essence, and Oliver hated calls like these because he had to play God and choose who lived and who didn't.
Who was he to make a decision like that?
Who was anybody?
"Hey, Gibbs. Look at me."
Gibbs tried. His eyes found Oliver's for a beat, then they drifted away. The pink foam dripping out of his mouth was clinging to the corner of his lips. "He's crashing," Oliver said.
Scott had Gibbs's arm extended on the carpet and was already taping the IV line into place. "First one's in."
"Good," Oliver said.
Oliver's thoughts temporarily wandered and he wondered whether Scott knew that he was scared out of his mind right now, or if he knew that he was also curious about who would clean all the blood off the blinds and the walls once they were gone.
He'd thought that he'd already seen all the darkest corners this job had to offer but, once again, it seemed he'd been proven wrong.
The crack of the wood floor under someone's boots shook something loose in Oliver's mind and time rewound.
Not but a moment ago, Scott and Oliver had been stacked outside the apartment door in a dingy hallway next to two extremely huge cops who were stuffed into their uniforms like sausages. Officer Chris Gibbs had been standing in the center of the door frame, Officer Carey Kehl on his left, Paramedic Scott Hollis on his right, and Oliver in the middle of all of the men, excited to see someone get tased — again. Seeing people get tased was one of the perks of the job no one told you about.
He remembered yelling, "Travis," through the hollow-core door. "My name's Oliver. I'm a paramedic with the City."
Then there was a sudden movement inside and a voice that answered.
"You with the ambulance or with the health plan?"
Oliver shot Gibbs a confused glance, then focused back at the door. "I'm with the ambulance."
For half a beat, they could only hear his breathing on the other side of the door. And not the breathing of a man calming down, the breathing of a man trying to decide whether the voice on the other side of the door belonged to a person or to the thing that had been talking to him all night.
Then Travis Rawlins said, "You know what they're calling it now?"
"Calling what?"
"Resource optimization. Can you believe that?"
Officer Kehl shifted beside his partner, obviously not patient enough to coax the man out politely. "Travis, open the door. Now."
But Rawlins kept talking over the commands, his voice was closer now, right against the other side of the door.
"They've already flagged me," he said. "You know what their flag says? 'Denied: Low-yield patient'. Like I'm a crop. Or a bond. I'm basically a row on a company's spreadsheet."
"Travis. Open the door and let us help you."
"Help me?" The laugh that came through had no humor in it. "I'll just get flagged and you'll filter me to some other care organization and delay everything I need for help until I'm forgotten. You'll push me somewhere cheap and call it care." Officer Kehl gave Oliver a second look that said he'd had enough and started to move, but Rawlins spoke one more time, quieter, almost to himself.
"You don't practice medicine anymore. You measure the financial risk and then call it care."
The lock snapped open.
The door flew inward, and Travis Rawlins came through it like a wrecking ball. He didn't look at the cops or the tasers they were holding and went straight for Oliver.
Rawlins grabbed a fistful of Oliver's uniform and pulled him forward into his apartment hallway wall, hard enough to rattle the dusty light fixtures in the kitchen. The other two cops pushed in from the entryway behind them and tried to tear them apart, but Rawlins kept dragging Oliver with him like he had been picked as the one man in the room that he wasn't going to let go of.
Officer Gibbs grabbed the man and tried to wrench him away from Oliver, and for a split second, an opening to the outside hallway presented itself between the cops and offered a clean path of escape for the man.
But he didn't take it.
Instead, he lunged forward again, both of his hands this time reaching for Oliver's uniform, like that was the only thing in the room he cared about.
"You don't even know what you're a part of," Rawlins snarled, dragging Oliver sideways into the wall hard enough to blur the light.
"What am I a part of?"
Rawlins's eyes were huge, bright, and fixed on Oliver's paramedic patch like it meant something different to him than it did to anyone else in the room.
"Their lies," Rawlins said. "Their denials." Rawlins's grip tightened on the front of Oliver's uniform like he was trying to pull him close enough to whisper in his ear through all the noise.
"You may not remember me, but I remember you."
Oliver barely had time to register the words before Rawlins's hand slid down across his chest, fingers fumbling hard against the front of his uniform shirt near the front pocket seam. It felt less like a strike than the desperate shove that it was. The movement felt deliberate but was buried in the violence of the struggle.
Oliver jerked backwards on instinct, thinking that the man was reaching for his radio, his pen, his throat, anything.
Then Rawlins's hand was gone.
His mouth opened again, his breath hot and ragged, his eyes still locked on Oliver.
"Don't let them win."
Then Officer Gibbs crashed into him and the room came apart.
The algorithm is already running.
Oliver just doesn't know it yet.
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