After I’d admitted three patients, I found myself in great need of a nicotine fix. While I felt guilty for sticking the other doctors with a few extra cases, I didn’t feel guilty enough to forgo a quick cigarette break.

I was heading for the ambulance bay doors when John Doe arrived.

Dr. Fuller, the attending physician and most senior M.D. in the hospital, ran alongside the gurney, barking instructions and demanding information from the EMTs in his no-nonsense Texan accent.

Distracted by the fact that Dr. Fuller’s smooth, Southern speech had been replaced by an urgent, clipped tone, I didn’t notice the patient on the gurney. I had never seen my superior lose his unflappable calm before. It scared me.

“Carrie, you gonna give us a hand here or are you on a one-way trip to Marlboro country?” he barked, startling me. The cigarette between my fingers snapped in half when I jumped, reduced to a fluttering shower of dry tobacco. My break had been officially canceled.

I brushed my hands clean on my lab coat and fell into step beside the gurney. It was only then that I noticed the state the transport was in.

The sight of the patient paralyzed me as we entered the cubical and the EMTs were squeezed out to make way for the R.N.s who rushed in.

“Okay ladies, I want splash guards, gowns, goggles, the whole space suit. Quickly, please,” Fuller snapped, shrugging off his blood-smeared white coat.

I knew I should do something to help, but I could only stare at the mess on the table in front of me. I had no idea where to start.

Blood might be the one thing I’m not afraid of. In the case of John Doe, it was not the blood that made working on him, touching him, even approaching him unthinkable. It was the fact that he looked like my dissection cadaver on the last day of Gross Anatomy.

Puncture wounds peppered his chest. Some were small, but four or five were large enough to fit a baseball in.

“Gunshot wounds? What the hell was he shot with, a goddamned cannon?” Dr. Fuller muttered as he probed one of the bloody holes with his gloved finger.

It didn’t take a forensic-science degree to tell that what had caused the wounds in John Doe’s torso had not caused the wounds in his face. His jaw, or what was left of it, hung skinned from the front teeth to the splintered end, where it had been ripped from the joint to dangle uselessly from the other side of his skull. Above the gaping hole in his cheek, one eye socket stood empty and crushed, the eye itself and optical nerve completely missing.

“I’d say someone used an axe on his head, if I thought it were possible to swing one with enough force to do this,” Dr. Fuller said. “We’re not going to get a tube down this way, his trachea’s crushed all to hell.”