Ruthless Grace (Ruthless #4)

Chapter 1

GIA

The arctic blast of the medical wing’s air conditioning hits my bare forearms like a slap.

Outside the high stone walls of the Santoro compound, the New Orleans night is thick enough to drown in: an eighty-eight-degree swamp of stagnant river air, heavy humidity, and the sweet, cloying scent of night-blooming jasmine.

Inside our private ground-floor medical wing, it is fifty-eight degrees, smelling of industrial disinfectant, sterile stainless steel, and cold iodine.

I stand at the scrub sink, my feet planted wide on the damp rubber mat.

Five-foot-three on a generous day, running on three hours of dead-eyed sleep, two shots of Nonna’s dark chicory espresso, and pure, concentrated spite. Underneath my lab coat, I wear unisex size-medium scrubs. Faded green, boxy, and two sizes too big.

I buy them oversized on purpose. In a world where Cosa Nostra men price women by their hip-to-waist ratio and senior attending surgeons mistake a full bust for a lack of intellect, my scrubs are my camouflage.

They flatten my chest, erase my waist, and hide the plush, voluptuous hourglass figure my mother passed down to me before she died. The cotton boxiness forces every man in my orbit, whether he wears a stethoscope or carries a concealed Glock, to look at my eyes and my hands.

Nothing else is on the table.

I bend my head over the stainless-steel trough, hit the foot pedal with my heel, and let ice-cold water pour over my forearms.

Then I do the ritual.

I lift my hands, turn my palms toward my face, and roll my left wrist in a clean, three-degree circle.

One. Two. Three. Then the right. One. Two.

Three. The pre-scrub wrist-roll. The exact loosening motion every trauma surgeon does before taking a blade to skin or stepping into a blood-slick room.

My body preps for conflict the exact same way it preps for surgery, because in my family, they are the exact same procedure.

My right thumb finds the ring on my hand, a gold band set with a deep, square-cut emerald. Three generations of Santoro women deep. It belonged to my mother, Lucia, before cancer stole her from us inch by inch. My thumb turns the stone twice against my knuckle. A habit. A tell.

I look up at the double-paned observation window that separates the scrub bay from the medical wing’s private waiting corridor.

Beyond the glass, the Santoro famiglia has assembled like an invading army.

Renzo, our Underboss, stands closest to the glass, smelling faintly of gun oil and sandalwood, his eyes scanning the corridor for threats that don’t exist. Beside him stands Marco, our youngest capo, flexing his fingers over the black ink drawn across his knuckles, his shorthand for extraction routes.

And then there is Nico.

My twin. My mirror. He leans casually against the doorframe in a dark Italian suit, Mama’s wedding cufflinks gleaming at his cuffs.

He looks like the effortless diplomat, the family Consigliere who can charm a priest out of his collar.

But I know him. I see the microscopic tightness in his jaw, the old Moscow shadow that only Mila ever manages to quiet.

Nico catches me watching him through the glass. He doesn’t smile. He just tilts his head a millimeter, our twin shorthand. You ready, Gi?

I give him a single, barely perceptible nod. I’m always ready, fratellino.

Behind them sit the women. Nonna Rosa, her knuckles swollen and shining, her fingers moving rhythmically over her rosary beads as she whispers Cajun-Creole prayers under her breath.

Beside her sits Izzy, Renzo’s fiancée, her computer-calloused fingers curled around a dark phone screen she keeps waking up, checking for a message from Sofia that hasn’t come.

And Mila, who still hasn’t let Nico put a ring on her hand, her pale gray-green eyes quiet, holding herself with the straight, unbroken spine of a Bratva Pakhan’s daughter.

They are all waiting on one thing. On my hands.

No Santoro child is born in a public hospital.

In Cosa Nostra, a child born to the Don is a target before she ever takes her first breath.

My niece is a principessina of the Gulf Coast, and her first cry belongs inside these compound walls, protected by twelve-foot iron gates, three layers of armed enforcers, and her aunt’s sterile blades.

The automatic double doors of the medical wing’s surgical suite hiss open behind me.

“Dr. Santoro,” the scrub nurse calls out, her voice tight over her mask. “Donna Cassia’s contractions are ninety seconds apart. Fetal monitor is spiking.”

I shut off the water with my knee, snap on a pair of sterile size six-and-a-half gloves, and step backward through the doors into the clinical frost.

“Time to go to work,” I mutter.

In the center of the surgical suite, Cassia is gripping the side rails of the delivery bed, her knuckles bloodless.

Her dark hair is damp with sweat, clinging to her temples, but her eyes—those sharp, forensic-accountant eyes that can track a million dollars through ten shell companies—are wide and fiercely focused.

Dante is at her side. The Don who can order an execution over espresso without raising his pulse is sweating through his dark linen shirt, holding his wife’s hand like it is the only anchor tethering him to the earth.

“Inhale for four, Cassia,” Dante says, his low baritone thick with a panicked, hyper-protective edge I have never heard from him in my entire life. “Exhale for six. Per favore, just do the pattern the class taught us—”

“If you count to four in my ear one more time, Dante,” Cassia gasps, her teeth grinding together as another contraction tears through her, “I swear to God you are sleeping in the guardhouse until this child is in college. Cazzo!”

“Cassia, mia vita, you need to breathe— just take the epidural, please—”

“I am breathing!” she snaps, squeezing his hand so hard I hear his leather watchband groan. “And I told you I didn’t want the epidural! I read three medical journals on this! An epidural slows down the second stage of labor and makes the baby lethargic!”

“The baby wouldn’t be lethargic,” Dante shoots back, glaring at me over the sterile blue drapes. “Gia, tell her! Tell her she’s allowed to take the drugs!”

“I am the Chief Financial Officer of this family,” Cassia wheezes, glaring right back at her husband. “I do not make sub-optimal medical decisions based on temporary pain!”

“You’re screaming in my ear!”

“Then cover your ears, Don Santoro!”

“Both of you, shut up,” I say, stepping between her elevated knees and adjusting the overhead surgical lamp.

The harsh, white light pools over the drapes.

“Dante, stop coaching her like she’s an enforcer in a tactical drill.

Cassia, your stubborn forensic logic is adorable, but you’re crowning. Give me a real push on the next wave.”

Cassia glares at me, then lets out a ragged exhale as the contraction peaks. “Fine.”

I reach out, my gloved fingers touching Cassia’s abdomen, feeling the rock-hard tension of her uterus. The fetal heart rate monitor mounted on the wall beeps in a steady, rapid rhythm. 140... 138... 135...

Then, without warning, the rhythm shatters.

110... 95... 82...

The alarm on the monitor shrieks, a high-pitched, electronic warning that cuts through the arctic room like a serrated blade.

“Deceleration!” the anesthesiologist barks from the head of the bed. “Fetal bradycardia. Heart rate is dropping fast!”

Dante’s head snaps toward the monitor, his eyes flaring with sudden, terrifying panic. “Gia! What’s happening?”

Inside my chest, the ghost wakes up.

The memory surfaces whole. A Sunday dinner in our dining room, the smell of Nonna’s ragù, my Papa passing the bread before his palm went to his chest and he hit the tile floor.

My knees on the cold marble, counting compressions, working with flawless, desperate hands, calling time of death in my calm doctor voice so my brothers could survive hearing it.

His heart, I had told them. It was his heart.

The tox screens came back long after the funeral flowers had died, and proved I was wrong. He had been poisoned right at our table. I was in the room. I was the expert. And I missed it.

Don’t fail them again, the voice in my head whispers, cold and venomous. Your hands couldn’t save your father on that dining room floor. Don’t let Dante’s child die on this table.

My heart slams against my ribs, a sudden, suffocating wave of adrenaline threatening to drown me. My thumbs twitch inside my gloves, a microscopic tremor of terror.

No. I slam the door on the panic. I bury the daughter who failed her father and bring Dr. Santoro to the front.

“Dante, shut up and hold her shoulders,” I command, my voice dropping so low and sharp it slices through the shrieking alarm. “Cassia, look at me. Look at my eyes.”

Cassia’s wide, terrified gaze locks onto mine.

“The cord is wrapped,” I say, my hands moving with blind, instinctual precision beneath the drapes.

I slide two gloved fingers past the pubic bone, feeling the smooth, rubbery coil of the umbilical cord pinched tight against the baby’s neck.

“She’s hooked on her shoulder. I’m going to unloop her.

I need you to push with everything you have on three. Do you hear me?”

Cassia nods once, her jaw set.

“One,” I call out, my fingers hooking gently around the slippery cord, maneuvering it over a tiny, miniature ear.

“Two...”

I ease the loop over the soft crown of the baby’s head, relieving the pressure on her neck.

“Push!”

Cassia lets out a guttural, primal scream that echoes off the sterile tile. Dante grips her hand, leaning over her, his face buried against her temple as he whispers frantic, broken Italian against her skin.

I guide the tiny shoulders through the birth canal, my bare hands working through the blood and vernix, steady as marble. The tiny chest clears the drapes. Then the hips.

At twelve-fourteen in the morning, I lift Dante Santoro’s child into the harsh light of our compound’s medical wing.