Charlie St. Cloud Page 0,71

immediately by the reality of her condition. Her skin was almost blue. Her pupils were pinpoint. She had a contusion on the back of her head. She had no detectable pulse.

He had gotten there too late.

His heart was filled with alarm as the survivalman unpacked his emergency kit. The guy didn’t waste a word, moving with urgency and efficiency. In this barren spot of gray and cold, Charlie noticed the man’s clear blue eyes and pink cheeks. He knew the type. He had trained with them as a paramedic. They were known as airedales, an elite breed. Charlie had always dreamed of joining them and dropping into danger to save lives.

“She’s hypothermic,” Charlie said. “I’ve been doing CPR for twenty minutes.”

“Good,” he said. “We’ll take it from here.” Deftly, gently, he began to cut Tess from the rope, and Charlie admired his skill. Any sudden movement of the arms and legs of severe hypothermia patients could flood the heart with cold venous blood from the extremities and induce cardiac arrest.

Then the survivalman radioed the helicopter that he was ready, and a rescue hoist litter dropped from the air.

“Where you taking her?” Charlie asked, praying the answer would be a hospital and not the morgue.

“North Shore Emergency. Best hypothermia unit around.”

Charlie watched the survivalman lift Tess into the stretcher harness and strap her in. He hooked his belt to the cable, gave the thumbs-up sign to the winch operator, and they lifted off from the rock. Charlie stared straight up into the pounding rotor wake as the basket swayed and was finally pulled inside the helicopter. Then the Jayhawk tilted forward and climbed into the west.

The waves crashed into the rock, and the spray stung his eyes. He watched the orange and white helicopter fade away, and his vision blurred. He was all alone on a rock in the Atlantic, but now he had a shred of hope. He folded his freezing hands, closed his eyes, and prayed to St. Jude.

THIRTY-TWO

CHARLIE HATED THE EMERGENCY ROOM. IT WASN’T looking at these ill and anxious people that unnerved him. He was uncomfortable because of what he couldn’t see but had always sensed. His gift had never extended beyond the cemetery gates, but he knew the spirits were there in the hospital, hovering near their families or patrolling the long halls. In the land of the living, the ER was the way station, the earthly equivalent of the in between.

Was Tess’s spirit here now? he wondered, as he sat on the hard Formica chair and listened to the fish tank bubbling across from him. Was she floating in the fluorescent haze of the waiting room? He closed his eyes to rest, but his mind would not stop going. He had spent the last two hours in a frantic, careening race to the hospital, desperate to get to Tess and find out her medical status. But no news. The doctors weren’t out of the OR yet, and even his old friends on the nursing staff didn’t know a thing. Tink sat on the other side of the room. Big fingers poking at his little cell phone, he was dialing numbers all over Marblehead, letting folks know Tess was in the hospital.

Charlie tried to calm himself, but his thoughts kept circling back to the Rule of Three, which had been a fixture of his paramedic training. In desperate situations, people could live for three minutes without oxygen, three hours without warmth, three days without water, three weeks without food. So Tess still had a fighting chance.

He also knew that folks with severe hypothermia often tended to look dead. He reviewed the crucial indicators: hearts slowed, reflexes ceased, bodies stiffened, pulses undetectable, pupils unresponsive. Doctors called this a state of suspended animation or hibernation, the physiological place between life and death. And that was why ER physicians never gave up on exposure victims until they tried to heat the body, blood, and lungs. “You’re not dead until you’re warm and dead,” they liked to say.

In the best-case scenario, Tess was still in between and could be brought back to life, just the way Florio had resuscitated Charlie in the ambulance. The first step was to deliver heated oxygen at a temperature of 107 degrees. The Coast Guard rescuers had surely pumped warm air into her to stabilize heart, lung, and brain temperatures. Next, they would have applied thermo-pads to her head, neck, trunk, and groin to defend her core temperature. Then they would have administered warm fluids