"HEART RATE'S CLIMBED TO 148," Lauren Barclay warned, her words blending with a monitor alarm in dark harmony. The clatter of resuscitation equipment being hustled into place by fellow ER nurses snuffed out the rest of her report. A strangled gasp from the head of the gurney validated Lauren's concerns: this man was failing in the painful struggle to fill his lungs. Her stomach knotted. They couldn't lose him. Not the brother of one of their team.

Please ...

"O2 saturation is tanking, Doctor." She grabbed the hissing suction catheter and wedged closer, determined to get the physician's attention. Her eyes watered at a sudden whiff of iodine and alcohol. "His skin's really gray."

"I see that, Lauren—I'm not blind." The physician pulled the fiber-optic scope from his patient's mouth, growling with frustration. "Suction! Clear his airway."

"Got it." Lauren moved in quickly, a respiratory therapist behind her with the Ambu bag. She slid the catheter between the unconscious man's lips, struck again by the familiarity of his features: dark hair and lashes, that hint of olive in his complexion despite his pallor. She'd have known he was Eli Landry's older brother even without seeing the medical record. Andrew Landry, thirty-six years old, had suffered a traumatic brain injury twenty-some years ago—a boating accident and near drowning that left him comatose on a ventilator for many months afterward. And severely disabled since. He was a man who should have been remarkably handsome, vital—embracing a hopeful, successful life—but was instead gaunt, withered, almost helpless. And dying?

Lauren glanced at his half-closed lids, the stray curl clinging to his clammy forehead. She'd never actually seen Andrew before today, but his tragic history was well known in Houston because his father—

"Hyperventilate him," the doctor ordered as a respiratory therapist slid a mask over the man's face. "And restrain those arms if you need to. Arm—he only has the use of the left one." He pulled off dark-framed glasses and wiped them with the hem of his scrub top, watching as the therapist began to squeeze the bag to assist respirations. "He's going to quit breathing. If I can't get this tube in, I'll have no choice but to trach him."

The physician ran a gloved finger over a thickened, pearly scar on his patient's throat, uttering something that sounded like "Why me?" He met Lauren's gaze at last. "Look, I'm sorry for snapping at you." Despite the air-conditioning, the young man's thinning hairline and forehead glistened with perspiration. Nervous sweat. It spread across the neckline and chest of his green scrub top, as if the stifling June humidity had slammed through the doors of Houston Grace Hospital along with the rushing ambulance gurney. "It's just that—"

"He's Eli's brother," Lauren finished in a raw whisper, the physician assistant's name never failing to cause her discomfort.

"And Judge Julien Landry's oldest son." The doctor lowered his voice. "Eli and his father have been at odds about Andrew for months. Everyone knows that. I need to be in the middle of that battle like I need a hurricane to flatten my house."

"I hear you." Lauren's gaze darted toward the hallway that led to the ambulance bay. The Caribbean was brewing a trio of tropical storms. She'd almost prefer that over what might happen here today. Things were tough enough without added conflict. She'd moved back to Houston—accepted a position in this ER—to keep a protective eye on her younger sister, Jessica. The twenty-one-year-old was making reckless choices, and if she didn't straighten up, her job at Houston Grace was at risk. As was her acceptance into nursing school in the fall ... and even her life? No. Lauren refused to believe Jess's problems were that serious. Unfortunately, there was one thing she couldn't deny: Eli Landry was part of the whole mess.

"Okay, then." The doctor signaled to the respiratory therapist that he was going to attempt another intubation. He glanced at the clock, then turned to Lauren. "What time is Eli due in the urgent care?"

"Not till four, unless he's heard—"

There were voices outside the code room doors. A woman, their emergency department manager. The other voice was much deeper.

"Is that ...?" The physician's gaze moved to the doorway, and the room went strangely quiet except for the whoosh-burp of the plastic mask bucking against its seal over Andrew Landry's face.

"Oh no." The words slipped out before Lauren could stop them. "He's here."

* * *

Eli Landry shoved the code room doors open, telling himself the same thing he always did: he was prepared for whatever he'd find. After years of trying, he still hadn't convinced himself.

"Eli ..."

The ER doctor, Mike Duhain, walked toward him. Sweating—always a bad sign.

"Mike." Eli looked at the heart monitor: tachycardic but regular. Only then did he allow his gaze to move to his brother's face, partially obscured by a translucent green resuscitation mask. Alive. He released the breath he'd been holding. "What's going on with Drew?"

"The care home told the medics he was breathing hard last night, sleepy today. Had a shaking episode. He arrived here with severe respiratory compromise and hypoxemia." Mike glanced toward the monitors as an alarm sounded. "Oxygen saturation's 89 percent even with the high-flow bag assist."

"Fever?" Eli noticed for the first time that Lauren Barclay was in the room. Pink scrubs, honey-colored hair rebelling against the summer humidity. Only concern for his brother could have provided enough distraction to make him miss such a staggering sight.

"His temp was 104.2," she reported, moving to the computer a few feet from where they stood. She managed to avoid Eli's eyes—a skill she'd perfected since her return to Houston. Right now, he was grateful. The last thing Eli wanted—besides for his brother's heartbeat to suddenly flatline—was to see disapproval in Lauren's eyes. Had she heard what was going on with his family?

"We sent blood to the lab and they're drawing for arterial gases now," Mike continued. " X-ray is coming for a portable chest; I hear coarse crackles throughout. I've made a couple of attempts to tube him. I was about to try again with a smaller—"

"You won't get a tube in," Eli interrupted. "His trachea's a mess. There's scarring and stenosis. Every med student and rookie paramedic in the county has used my brother for practice."

He knew he'd spit out the last word and reminded himself that Mike Duhain was a skilled doctor and a more-than-decent guy. He was also providing physician support for Eli's shift in the adjacent urgent care department. It would be an unwelcome role reversal for a PA to direct a board-certified emergency department physician. And unethical because this was a family member, but ...

"Drew had that first trach after the accident," Eli explained further, "and then an emergency crike during a drug reaction three years ago—multiple traumatic attempts to get that tube in. More scarring. And he's had fractured ribs, sternum, and a contused spleen when some cowboy first responder couldn't tell he didn't need cardiac compressions." Eli's gut roiled. "My brother has been through way too much."

Mike swiped at his forehead. "I hear you. But...