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Jen Tilly presented next. A fifty-year-old woman had died of cirrhosis due to chronic alcohol abuse.

The presentation was fast and streamlined nicely by Jen’s meticulous preparation.

Livia switched spots with her. It suddenly felt odd to be in the front of the cage.

Although lately Livia had striven to be here, in front of Dr. Colt and her other teachers, today was an anomaly.

All morning, throughout the autopsy and then during the afternoon when she prepared her presentation, her thoughts had been with Nicole.

Like a computer application running in the background and drawing down her phone’s battery, the left-side analytical portion of her mind had been working all day on Casey Delevan and his connection to her sister.

But now, with thirty sets of eyes on her as she stood in the glow of the Smart Board projector, Livia was finally forced to focus her mind on the fall victim she had autopsied.

She was surprised to find such a scant amount of information to work from, as if suddenly she was taking that final exam from her dreams for a class she had never attended .

She fumbled through the findings of her external exam, covering the left-side lividity, the bruising, and the broken wrist. She went through the mostly unremarkable findings of the internal exam, noting the presumed time of death based on stomach content and suspected time of last meal.

She moved to the neurological findings, covering with some confusion the midline shift she presented as the cause of death.

“What did the QuickTox tell you?” Dr. Colt asked from the darkened gallery of the cage.

Shit .

A QuickTox was an abbreviated toxicology report that quickly identified chemicals in the bloodstream, and was a precursor to the full toxicology report that typically took days to return. Livia had sent samples to the lab, but hadn’t run a QuickTox.

“I didn’t think to run one. I felt pretty certain in this case that the cause of death was midline shift.”

The moment of silence that followed her statement was the most uncomfortable time Livia had spent in the cage. She knew what was coming.

“Is that how we practice medicine, Dr. Cutty? By being ‘pretty certain’ about things?”

“No, sir.”

“Why is there no QuickTox in your presentation?”

“An oversight,” Livia said.

“A startling one, Dr. Cutty. Can you please tell us which medications your patient was taking?”

Livia stumbled with her words as she shifted through her notes. “I don’t have that information with me.”

“You don’t have that information with you?

” Dr. Colt repeated. He referred to his notes.

“This patient was taking eight different medications. One of which was a new Rx for OxyContin, given for recent onset of neck pain and headache. So we have an eighty-nine-year-old woman with a new onset of headache symptoms, prescribed likely too high a dose of an opioid analgesic, who possibly fell as a result of a drug interaction. And you don’t have that information in front of you?

” Dr. Colt went back to his notes for reference.

“She was also taking the acid reducer cimetidine, which is not meant to be taken with OxyContin. Cimetidine increases the blood levels of OxyContin, which can cause dizziness, low blood pressure, and fainting. All quite relevant to a fall victim.”

Dr. Colt continued as his voice elevated.

“Or, we have a stroke victim who’s been having headaches for the past week and collapsed as a result of said stroke.

However, the very examination performed to determine if any of these mechanisms played a role in her death didn’t actually cover any of these possibilities.

So I ask you, Dr. Cutty: This morning, did you see someone’s mother on your table?

Did you see someone’s wife? Or did you simply see an old woman who fell in her bathroom and hit her head? ”

He looked back at his notes. “Did you simply see one hour and fifty-four minutes out of your day lying on that table? Because with the reckless manner in which you handled this case, I’m betting on the latter.”

The cage took on a heavy quiet when Dr. Colt finished his rant. He stood up and walked to the front of the room, taking a place next to Livia.

“Let Dr. Cutty’s case be an example for all the fellows in this program.

We want you to make progress during your training.

And with progress comes respect. But when you rest on your laurels and put up shoddy work under the cover of that respect, you will be called out.

Keep it up, and you might lose the respect you’ve worked so hard to earn over the past three months.

Every single human body that comes through this place is someone’s wife, brother, son, uncle, sister.

Treat them that way. That’s why we hired you, and that’s what you promised us. ”

Dr. Colt walked out of the cage and left each of its occupants quiet and uncomfortable as they slowly shuffled papers and headed into the weekend.

* * *

An hour later, Livia was sweating as she punished the Everlast bag. Randy leaned a shoulder into the leather to steady it as Livia went after it.

“Because you’re in such a nasty mood,” Rand yelled over the pounding. “I won’t mention your crappy form.”

“Good.” Livia grunted as she punched. She danced on her feet. “Tonight’s not about form, just anger.”

She released a combination of punches and kicks for the next twenty minutes until her fists were sore and her shins raw.

“Okay, Doc. That’s all my shoulder’s got in it.”

Livia put her hands on top of her head, breathing heavily. “Thanks, Randy. I’m done anyway.”

“Get it all out?”

Livia grabbed her water bottle. “Probably never get it all out.”

“Wanna tell me about it.”

She sipped from the bottle. “What would that do to my membership fees?”

Randy threw her a towel and waited.

“You have regrets in life, Randy? ”

“Too many to list.”

“Name your biggest.”

“Let’s see . . . I’ve got an eighth-grade education ’cause I thought selling drugs on a Baltimore corner was a career path.

I’ve got this”—he pulled down the collar of his shirt to reveal a shiny gray scar across his dark black skin—“because somebody shot me. And I gotta wake up each day knowing I’m alive ’cause I killed the guy who wanted me dead. ”

Livia stared at him a moment, then slowly nodded her head. “Okay, you trump me.”

Randy laughed. “Impossible. Not with regret.”

“No?”

Randy shook his head. “Nope. Regret, it’s got no size. Mine can’t be bigger than yours. My daddy always said: ‘You either got it, or you don’t.’” He pointed at the bag. “And you’re not gonna get rid of it by punching a bag.”

“Probably true.”

“So what is it? What’s your regret?”

Livia looked at the bag, then back to Randy. “Not answering my phone.”

* * *

That night Livia Cutty woke in her childhood bedroom under the same ceiling fan that kept her cool during the hot summers of her youth.

After her trip to the gym, she decided to get out of Raleigh.

With Casey Delevan’s picture in her purse she headed to her parents’ house in Emerson Bay.

Her original plan was to ask them about Nicole in the months before she disappeared.

To ask if her parents knew anything about the guy Nicole was dating.

Livia had planned to show them Casey Delevan’s picture and tell them his body had been pulled from the bay and slapped on her autopsy table.

That he was likely dead for more than a year, and if the timing added up he had been killed about the same time Nicole went missing.

Livia’s original plan had been to confess her suspicions that the man in the picture was somehow connected to Nicole’s disappearance.

She needed her parents’ help to figure out what Nicole was up to in the months before her death because, alone, Livia knew little about Nicole from that summer.

The sad truth was that her sister had fallen into the shadowed corners of Livia’s life in the years before she was taken.

Nicole’s rebellious attitude had driven Livia away.

She blamed her absence from Nicole’s life on her residency and the looming decision to pursue a fellowship or move straight into the workforce.

She claimed to have no time for her sister, even when Nicole had asked that summer to stay with Livia for a week.

“I just need to get out of Emerson Bay for a while,” Nicole said.

“And come here? Nic, there’s nothing to do here,” Livia said.

“I don’t care. I’m okay doing nothing. As long as I’m not here.”

“I spend twelve hours a day at the hospital.”

“I don’t care. We can hang out when you get home at night.”

“Nicole, I get home at eleven o’clock. Sometimes later. Then I get up early and start it all over again. It’s what you do in residency. I’m not going to be able to entertain you, or take you out. ”

“I don’t care, Liv. I just want to get away from everyone here.”

“I know high school is hard, but you’re done with that now. You’ll be off to school in the fall and you’ll make new friends. Trust me. Coming here will depress you.”

Silence.

“Nic?”

“What?”

“It’s your last summer before college. Enjoy it, okay? Just give up on all the drama. It’s pointless.”

“So I can’t come see you?”

“In three weeks I’ll be home for a long weekend. We’ll talk then.”

Nicole went missing from the beach party a week later. Livia had tucked that conversation into the dark recesses of her mind and covered it with a heavy dustcloth. It was a protective measure: compartmentalizing the times she had failed her sister.