“Hallelujah!” he said, moving back to her. “It’s thick, but it’s about the best we could hope for.”

“You mean it’s thicker than the bullet hole?”

“We’ll find out. With a .22, the track through your body will have swelled shut, but not permanently. Which means . . .”

“What? Tell me!”

“To drain the pericardium, you’ve got to get the tip of that pen barrel to it. To get that tube to your pericardium, you’ll have to reopen the wound.”

“So?”

“The pain will be severe. And with my hands cuffed behind me, I can’t do the procedure.”

“Then tell me what to do!”

Tom stared at her for a few seconds, then at the wound. He shook his head slowly. When she began to sob, he sighed and said, “Take the ink tube out of the pen barrel and throw it on the ground. Then open that knife and get ready to use it.”

Caitlin stuck the pen’s point between her teeth, bit down, and yanked out the ink-filled insert. Then she slid a fingernail under the edge of the blue end cap and popped it out. What remained was a strong hexagonal tube about six inches long. Awfully thick for a needle, but better than nothing.

“What about sterilization?” she asked.

Tom actually laughed. “Infection is the least of our worries. You just worry about getting that Bic to your heart.”

“I’ll do it. Tell me what to do.”

Tom knelt before her, then allowed himself to fall onto his butt. As he coached her, his eyes moved constantly between her eyes and the bullet hole. Caitlin felt like she was about to climb Everest or jump out of an airplane, and Tom was the only instructor she would ever have.

“In a clinical setting we’d have an ultrasound machine to guide the needle. You’re going to have to go by feel. But first you have to widen the hole. You’re going to insert the point of the blade, then work it along the track of the bullet by touch—widening the track as you go. It won’t be easy—first because it will hurt like hell, second because the point might hang up in tissue all along the way. You’ve got to ignore the pain, but not altogether, because if you blot it out totally, you might go too far and hurt yourself worse, or pass out.”

“I understand. How do I keep from going too far?”

Tom considered this question. “That’s my job. I’m going to watch you closely. Once you have the blade halfway in, you’re going to guide the pen barrel along the blade, then push both toward the pericardium. Don’t be surprised if you get a squirt of blood. There’s quite a bit of pressure in that sac right now.”

“Won’t there be blood the whole time?” she asked.

“Not that much. When you reach the pericardium, you’ll know.”

She had a feeling he was underplaying the horror she might soon experience.

Tom tried to smile. “All right, let’s do it. If you pass out, this isn’t going to get done.”

Dropping the Bic between her legs, Caitlin picked up the multi-tool and looked at the knife blade. Three inches of tempered steel with a glittering edge . . .

“Don’t think about it,” Tom said. “Just do it.”

As she contemplated shoving that blade into her chest, something froze her hands. She was thinking of a scene from The Texas Chainsaw Massacre in which a character slices open his own palm with a pocketknife.

“Cait . . . ? Come on, girl. You can do it.”

“I know. Fuck it.” She grabbed a twig from the mud, stuck it between her teeth, and bit down as hard as she could. Then she shoved the point of the knife into the bullet hole and pushed it slowly but steadily toward her heart. The twig flew out of her mouth when she screamed. She saw keen empathy in Tom’s eyes, but also resolve.

“Keep going,” he urged. “If you stop, you won’t start again.”

She pressed the blade deeper, and fire seared her chest. When she wiggled the blade in the wound, the pain was nearly unbearable.

“Back it out a little,” Tom advised. “The point’s probably buried in tissue.”

She did as he advised, and blessed relief was her reward.

“Okay, back in. You’ve probably got another inch to go.”

She shut her eyes and drove the knife deeper into the wound track. It was like threading a catheter into your bladder, only a catheter that had been heated to a thousand degrees Fahrenheit.

“Stop,” Tom said. “It’s time to put the pen barrel in there.”

Christ, she thought, shivering from adrenaline. She picked up the clear barrel of the Bic and held it along the knife handle, its narrow end near the bullet hole.

“Be deliberate,” Tom said.

The pen barrel actually hurt worse than the blade, because of its thickness. She groaned and screamed each time the tube penetrated deeper into her chest, and as it disappeared, she realized that her breathing was even more difficult.

“That’s as far as I can go without cutting more,” she gasped. “What’s the fucking problem?”

“Stay still. I want to try something.” Tom bent at the waist and put his gray lips around the pen barrel. After taking a deep breath through his nose, he began sucking as hard as he could.

How can he do that? she wondered. And then she realized something that brought tears to her eyes. Tom loved her. Her, and the child that she carried within her. This procedure was a brutal act of self-preservation, not for themselves alone, but for each other and for their family.

“Keep going,” she urged, as Tom’s face reddened.

Despite his effort, nothing darkened the clear tube. At length, he pulled back his head, gasping for breath. “I’m light-headed. You’ve got to go deeper . . . and faster. I think my sugar’s bottoming out again.”

“Did you finish that peppermint I put in your mouth?”

“I didn’t know I had one. All I knew was I was choking on something.”

“You should find whatever’s left so you can eat it. That’s all I had with me.”

“I’d better look. Getting to the pericardium is only half the job.”

A blast of panic went through her. “What are you talking about?”

“Take it easy. Now, what’s keeping your heart from bleeding out—probably the left ventricle in this case—is the pressure of the blood in the pericardium. Since we have no way to plug the hole in your heart, if we drain too much blood from the sac around it, there’s no more pressure to hold in the blood. You understand?”

“You’re telling me that if we somehow succeed at this, I’m going to bleed to death.”

“No, you’re not. The trick is to drain out enough blood to let your heart pump well, and get your blood pressure back up, but not so much that you bleed to death. We can do that by plugging the end of the pen barrel with a finger. Okay?”

“Okay.”

“But to do that, at least one of us has to be conscious.”

Caitlin gritted her teeth against the fire in her chest. A runnel of blood slid down her bare belly. She looked up at Tom, her jaw set tight. “Go find that goddamn peppermint.”

While Tom knee-walked into the Bone Tree, Caitlin gingerly held the knife and pen barrel as steady as possible in her chest. She feared that any second a jet of blood would burst from the tube, and she would die. To block out that image, she focused on the pain, which reminded her of going to the dentist when she was a child. Her father had always taken her to an elderly practitioner who seemed not to have heard of Novocain. He took forever to fill teeth, and she always felt like he was drilling directly into a living nerve. Ice and fire living together in the heart of a tooth: that was what she felt now beneath her breastbone.

“I couldn’t find it,” Tom croaked, falling beside her again. “Most of it probably melted before I came to. How do you feel?”

Caitlin nodded, unwilling to waste breath answering.

Tom gave the buried steel an appraising look. “Time to try again.”

She took a deep breath, then drove the steel and plastic still farther toward her heart. When she’d probed as deeply as she dared, Tom leaned down again to begin sucking, but before he could, dark blood spurted into his eyes.