What Was Beneath the Cast
Emily’s eyes opened halfway, then closed again.
Her breathing had become shallow and fast.
Marcus read out another blood pressure.
It was worse than the previous one.
We moved.
Fluids were already running.
We started treatment for severe infection while I positioned Emily’s arm and checked her fingers again.
Still purple.
Still cold.
Still almost no color returning when I pressed them.
Daniel stepped closer.
“Emily hates hospitals,” he said. “She gets worked up. That’s probably why her numbers are bad.”
I looked up at him.
A fever of 103.8 degrees wasn’t anxiety.
A heart rate near 140 wasn’t somebody being dramatic.
A foul odor coming from inside a month-old cast wasn’t nervousness.
And blue fingertips weren’t a personality trait.
“Stand back, please.”
He didn’t.
Marcus didn’t raise his voice.
“Sir, you need to give us room.”
For several seconds, Daniel looked as though he were calculating which one of us he could persuade.
Then he backed away.
Barely.
I started cutting.
A cast saw vibrates rather than spinning like a traditional blade, but patients are often afraid of it anyway.
Emily barely reacted to the sound.
That frightened me more than if she had pulled away.
I worked down one side.
Then the other.
The smell intensified almost immediately.
Marcus turned his head for half a second, then looked back at the monitor.
Daniel said:
“She got it wet once.”
I hadn’t asked him anything.
He continued anyway.
“In the shower. A little. We dried it.”
I stopped and looked at him.
“When?”
“I don’t know. A week ago. Maybe two.”
His answer came quickly at first, then became vague exactly where the timeline mattered.
I returned to the cast.
When the fiberglass shell finally loosened, I separated it carefully instead of pulling.
The padding underneath was damp in places and badly discolored.
Emily’s forearm was massively swollen.
There were large areas of severe inflammation and extensive skin breakdown where the cast had trapped moisture and pressure against tissue that had no room left to swell.
Near the wrist, it was worse.
The infection had clearly been developing for more than a few hours.
This was not something that appeared between breakfast and lunch.
Marcus stared at Emily’s arm.
“Sarah.”
“I see it.”
I checked her hand again now that the pressure of the cast had been released.
Then I noticed something else.
Above the worst area, near the upper edge of where the cast had been, were older bruises in different stages of healing.
Not proof of how they happened.
Not an answer by themselves.
But enough to make Daniel’s sudden desperation about keeping the cast closed feel very different.
He saw me looking.
“She bruises easily,” he said.
Again, I hadn’t asked.
I turned toward him.
“How long has her hand been this swollen?”
“It hasn’t.”
Marcus looked at me.
Daniel corrected himself.
“I mean, not like that.”
“When did her fingers start changing color?”
“They weren’t purple at home.”
“When did she first complain that the cast felt too tight?”
“She didn’t.”
A faint voice came from the bed.
“Yes.”
Daniel’s head turned sharply.
Emily’s eyes were open.
Only barely.
But she had heard him.
I leaned toward her.
“Emily, can you hear me?”
She gave a tiny nod.
“Did you tell someone the cast felt too tight?”
Her cracked lips moved.
“I told him.”
Daniel stepped forward.
“She’s confused from the fever.”
I held up one hand without looking away from Emily.
“When?” I asked her.
She swallowed.
“Days.”
One word.
And the room changed.
