Page 2 of Mercy Written in Blood

"Seventy-eight over forty-two."

"Heart rate?"

"One forty-six."

"GCS dropped from thirteen to nine en route."

The patient's face was grey beneath smears of road dirt, his eyes fluttering without focusing, his breathing shallow and uneven behind the oxygen mask. Renji placed two fingers against theside of his neck. The pulse beneath them was fast and thready, already fading.

"Move him across on three," Renji said. "One, two, three."

The trauma team transferred the patient onto the bed. Renji did not raise his voice. He never needed to.

Around him, the room organised itself. Scissors cut through torn leather and blood-soaked clothing. Leads were attached. A nurse called out oxygen saturation. Someone prepared rapid-sequence intubation drugs while another pushed the ultrasound machine into position.

"Akiko, airway."

"Already on it."

Akiko Sasaki appeared at Renji's shoulder, dark hair tucked beneath a surgical cap patterned with tiny yellow ducks. The absurdity of it had caused several junior doctors to underestimate her over the years. None had made the mistake twice. She tilted the patient's head, cleared the blood gathering at the corner of his mouth and had the airway trolley open before the anaesthetic registrar's hands were even on the tube.

"Aoi," Renji said, "activate massive transfusion protocol."

Aoi Nakamura was already at the phone.

"Done."

"Call theatre. Tell them we're coming."

"General or vascular?"

"Yes."

Aoi gave him a brief look. Renji did not look up from the ultrasound probe. There was free fluid around the liver — a great deal of it. He moved the probe lower, then pressed briefly against the iliac wings. The pelvis gave, unstable beneath even gentle pressure. The patient's oxygen saturation continued falling despite assisted ventilation.

"Absent breath sounds on the left," Akiko said.

"Chest drain."

A tray appeared. Renji cleaned the skin quickly, made the incision and pushed through muscle with a curved clamp. The moment he entered the pleural space, blood poured over his gloves and splashed onto the floor.

"Massive haemothorax," he said. "Record the output."

"Eight hundred millilitres immediately," Aoi called. "Still draining."

The monitor alarm changed pitch.

"Pressure sixty systolic."

"First unit going in."

The tube was secured. Akiko listened over both lungs.

"Tube's good."

Renji looked at the young man's face. Twenty-six, the paramedic had said. A faded festival wristband circled his right wrist, a silver ring hung from a cord beneath his torn shirt, and someone had written a phone number in black ink across the back of his hand — small evidence of a life that had existed normally an hour ago. Perhaps he had complained about work that morning, left dishes in his sink, or had someone waiting for him to answer a message.

"Renji."