“What is it you don’t understand?” asked Charles.
   “Dad!” called Jean Paul from the back seat. “Do they play hockey in Berkeley? I mean is there ice and all that?”
   Craning his neck so he could see Jean Paul’s face, Charles said, “I’m afraid there’s no ice. It’s more like continuous spring in Berkeley.”
   “How stupid can you be?” groaned Chuck, tapping Jean Paul on the top of the head.
   “Shut up,” said Jean Paul, twisting in his seat to swipe at Chuck’s boot. “I wasn’t talking to you.”
   “All right, pipe down,” yelled Charles harshly. Then in a calmer voice he said, “Maybe you can learn to surf, Jean Paul.”
   “Really,” said Jean Paul, his face brightening.
   “They only surf in Southern California,” said Chuck, “where all the weirdos are.”
   “Look who’s talking,” retorted Jean Paul.
   “Enough!” yelled Charles, shaking his head for Cathryn’s benefit.
   “It’s all right,” said Cathryn. “It reassures me to hear the kids bicker. It convinces me that everything is normal.”
   “Normal?” scoffed Charles.
   “Anyway,” said Cathryn, looking back at Charles. “One of the things I don’t understand is why the Weinburger made such an about-face. They all couldn’t have been more helpful.”
   “I didn’t understand it, either,” said Charles, “until I remembered how clever Dr. Ibanez really is. He was afraid the media would get hold of the story. With all those reporters milling around, he was terrified I’d be tempted to tell them my feelings about their brand of cancer research.”
   “God! If the public ever knew what really goes on,” said Cathryn.
   “I suppose if I were a real negotiator, I should have asked for a new car,” laughed Charles.
   Michelle, who had been vaguely listening to her parents, reached down in her canvas tote bag and pulled out her wig. It was as close a brown to Cathryn’s hair as she had been able to get. Charles and Cathryn had implored her to get black, to match her own hair, but Michelle had remained adamant. She had wanted to look like Cathryn, but now she wasn’t so sure. The idea of going to a new school was terrifying enough without having to deal with her weird hair. She’d finally realized she couldn’t be brunette for a few months and then become black-haired. “I don’t want to start school until my hair grows back.”
   Charles looked over his shoulder and saw Michelle idly fingering her brown wig and guessed what she was thinking. He started to criticize her for stupidly insisting on the wrong color but checked himself and said mildly: “Why don’t we just get you another wig? Maybe black this time?”
   “What’s the matter with this one?” teased Jean Paul, snatching it away, and jamming it haphazardly on his own head.
   “Daddy,” cried Michelle. “Tell Jean Paul to give me back my wig.”
   “You should have been a girl, Jean Paul,” said Chuck. “You look a thousand times better with a wig.”
   “Jean Paul!” yelled Cathryn, reaching back to restrain Michelle. “Give your sister back her wig.”
   “Okay, baldy,” laughed Jean Paul, tossing the wig in Michelle’s direction and shielding himself from the last of his sister’s ineffectual punches.
   Charles and Cathryn exchanged glances, too pleased to see Michelle better to scold her. They still remembered those dreadful days when they were waiting to see if Charles’s experiment would work, if Michelle would get better. And then when she did, they had to accept the fact that they would never know whether she had responded to the immunological injections or to the chemotherapy she had received before Charles took her out of the hospital.
   “Even if they were sure your injections had effected the cure, they wouldn’t give you credit for her recovery,” said Cathryn.
   Charles shrugged. “No one can prove anything, including myself. Anyway, in a year or less I should have the answer. The institute in Berkeley is content to let me pursue my own approach to studying cancer. With a little luck I should be able to show that what happened to Michelle was the first example of harnessing the body to cure itself of an established leukemia. If that…”
   “Dad!” called Jean Paul from the back of the car. “Could you stop at the next gas station?”
   Charles drummed his fingers on the steering wheel, but Cathryn reached over and squeezed Charles’s arm. He took his foot off the accelerator. “There won’t be a town for another fifty miles. I’ll just stop. We could all use a stretch.”
   Charles pulled onto the dusty shoulder of the road. “Okay, everybody out for R-and-R and whatever.”
   “It’s hotter than an oven,” said Jean Paul with dismay, searching for some sort of cover.
   Charles led Cathryn up a small rise, affording a view to the west, an arid, stark stretch of desert leading up to jagged mountains. Behind them in the car, Chuck and Michelle were arguing. Yes, thought Charles. Everything is normal.
   “I never knew the desert was so beautiful,” said Cathryn, mesmerized by the landscape.
   Charles took a deep breath. “Smell the air. It makes Shaftesbury seem like another planet.”
   Charles pulled Cathryn into his right arm. “You know what scares me the most?” he said.
   “What?”
   “I’m beginning to feel content again.”
   “Don’t worry about that,” laughed Cathryn. “Wait until we get to Berkeley with no house and little money and three hungry kids.”
   Charles smiled. “You’re right. There is still plenty of opportunity for catastrophe.”

Epilogue

   When the snows melted in the lofty White Mountains in New Hampshire, hundreds of swollen streams flooded the Pawtomack River. Within a two-day period, its level rose several feet and its lazy seaward course became a torrent. Passing the town of Shaftesbury, the clear water raged against the old granite quays of the deserted mill building, spraying mist and miniature rainbows into the crystal air.
   As the weather grew warmer green shoots thrust up through the ground along the river, growing in areas previously too toxic for them to survive. Even in the shadow of Recycle, Ltd., tadpoles appeared for the first time in years to chase the skittish water spiders, and rainbow trout migrated south through the formerly poisoned waters.
   As the nights became shorter and hot summer approached, a single drop of benzene appeared at the juncture of an off-load pipe in one of the new chemical holding tanks. No one supervising the installations had fully understood the insidious propensities of benzene, and from the moment the first molecules had flowed into the new system, they began dissolving the rubber gaskets used to seal the line.
   It had taken about two months for the toxic fluid to eat through the rubber and drip onto the granite blocks beneath the chemical storage tanks, but after the first, the drops came in an increasing tempo. The poisonous molecules followed the path of least resistance, working their way down into the mortarless masonry, then seeping laterally until they entered the river. The only evidence of their presence was a slightly aromatic, almost sweet smell.
   The first to die were the frogs, then the fish. When the river fell, as the summer sun grew stronger, the concentration of the poison soared.

Godplayer

Robin Cook

Prologue
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
Eleven
Twelve
Thirteen
Fourteen
Fifteen
Epilogue

Godplayer
by Robin Cook

   To Barbara and Fluffy—my constant companions and my most willing listeners

Prologue

   Bruce Wilkinson went from dead asleep to full awake with such suddenness that he felt overwhelmed with a sense of fear, like a child awakening from a nightmare. He had no idea what had awakened him but guessed it was some noise or movement. He wondered if something had touched him. He stayed still, holding his breath, and stared straight ahead, listening. At first he was disoriented, but as his mind took in his limited field of vision, he remembered he was in the Boston Memorial Hospital: in room 1832 to be exact. At about the same instant that he realized where he was, Bruce perceived that it was the middle of the night. The hospital was clothed in a heavy stillness.
   On his current admission for cardiac bypass surgery, Bruce had been in the hospital for over a week. But a month or so before he’d spent three weeks several floors down, recovering from his unexpected heart attack. As a consequence Bruce had become accustomed to the hospital routine. Such things as the squeak of the nurse’s medication cart as it was pushed up the hall, or the distant sounds of an arriving ambulance, or even the hospital page calling a doctor’s name had become reassuring phenomena. In fact, Bruce could often tell merely by listening to these familiar sounds what time of day it was without looking at his watch. They all signified that help for any medical emergency was close at hand.
   Bruce had never worried much about his health even though he was a victim of multiple sclerosis. The problem with his vision that had brought him to the doctor five years ago had cleared, and Bruce had made a conscious effort to forget the diagnosis because hospitals and doctors tended to frighten him. Then, out of the blue, came the heart attack with its attendant hospitalization and the current major surgery. His doctors assured him that the heart problem was not related to the multiple sclerosis, but that disclaimer had done little to buoy his sagging courage.
   Now, as Bruce awoke in the middle of the night and heard none of the usual reassuring hospital sounds, the hospital seemed like an ominous and lonely place, evoking fear rather than hope. The silence was intimidating, providing no immediate explanation for his sudden wakefulness. Bruce felt himself inexplicably paralyzed by a sensation of acute terror.
   As the seconds passed, Bruce’s mouth became dry, exactly as it had been after his preop medication five days earlier. He attributed this to fear, as he continued to lie perfectly still like a wary animal, his senses straining for any disturbance. He’d done the same thing as a boy after awakening in the night from bad dreams. If he didn’t move, perhaps the monsters would not see him. Lying on his back, he couldn’t see much of the room, especially since the only illumination came from a small floor-level night-light behind his bed. All he could see was the indistinct juncture of ceiling and wall. Silhouetted against it was the magnified shadow of his IV pole, bottle, and tubing. The bottle seemed to be swaying slightly.
   Trying to dismiss his fears, Bruce began monitoring his internal messages. The big question loomed in his mind: Am I all right? Having been rudely betrayed by his body by the heart attack, he wondered if some new catastrophe had awakened him. Could his stitches have split? That had been one of his fears immediately after the operation. Could the bypass have come loose?
   Bruce could feel his pulse in his temples, and, despite a clamminess to his palms and a somewhat disagreeable sensation in his head that he associated with fever, he felt okay. At least there was no pain, particularly not the crushing, searing pressure that had come with the initial heart attack.
   Tentatively Bruce took a breath. There was no stabbing knifelike pain although it seemed to take extra effort to inflate his lungs.
   In the semidarkness, a throaty, phlegm-laden cough reverberated within the confines of the room. Bruce felt a new surge of fright, but he quickly realized that it was just his roommate. Perhaps Mr. Hauptman’s coughing had been the sound that had awakened him, Bruce thought, feeling a modicum of relief. The old man coughed anew, then noisily turned over in his sleep.
   Bruce entertained the idea of calling a nurse to check Mr. Hauptman, more for the opportunity for Bruce to speak to someone than because he thought there was a real problem. The truth of the matter was that Mr. Hauptman coughed like that all the time.
   The disagreeable feverish sensation became more intense and began to spread. Bruce could feel it in his chest like a hot liquid. The concern that something had gone wrong on the “inside” reasserted itself.
   Bruce tried to turn to locate the nurse’s call button that was looped through the side rails of the bed. His eyes moved, but his head felt heavy. Out of the corner of his eye he saw quick, staccato movement. Looking up he could see his IV bottle. The movement he’d seen was coming from the rapid running of his IV. The drops in the micropore chamber were falling in quick succession, and the night-light glinted off the liquid with an explosive sparkle.
   That was strange! Bruce knew that his IV was only being maintained for emergencies and was supposed to run as slowly as possible. It should not be running quickly. Bruce could remember having checked it as he always did before turning out his reading light.
   He tried to reach out and find the nurse’s call button. But he couldn’t move. It was as if his right arm had not gotten the command. He tried again with the same result.
   Bruce felt his terror become panic. Now he was certain something terrible was happening to him! He was surrounded by the best medical care but unable to reach it. He had to get help. He had to get help instantly. It was like a nightmare from which he could not awaken.
   Yanking his head off the pillow, Bruce screamed for a nurse. His voice surprised him with its weakness. He’d intended to yell but instead he whispered. At the same time he became aware that his head felt tremendously heavy, requiring all his strength to keep it off the pillow. The exertion caused a trembling that rattled the bed.
   With a barely audible sigh, Bruce collapsed back onto his pillow, compounding his panic. Trying again to call out, he heard an incomprehensible hiss almost devoid of vocalization. Whatever was wrong with him was rapidly worsening. He felt as if an invisible lead blanket was settling over him, pressing him flat against the bed. His attempts to breathe were pitiful, uncoordinated heaves of his chest. With utter terror Bruce comprehended he was being suffocated.
   Somehow he organized his thoughts enough to remember again the nurse’s call button. With horrendous effort he lifted his arm from the bed, and in an uncoordinated, spastic fashion pulled it across his chest. It was as if he were immersed in some viscous liquid. His fingers brushed the rails, and he grasped vainly for the button. It wasn’t there. With the last vestiges of strength, he heaved himself onto his left side, rolling over and thudding up against the rail. His face pressed heavily against the cold steel, occluding the view from his right eye, but he did not have the strength to move. With his left eye he saw the emergency button. It was on the floor, curled on itself like a snake.
   Panic and desperation filled Bruce’s consciousness, but the oppressive weight on his body increased, precluding all movement. In his terror he guessed that something had happened to his heart; perhaps all the stitches had burst. The sense of being smothered intensified as Bruce’s brain screamed for life-giving oxygen. Yet Bruce was totally paralyzed, able only to grunt in agony as he desperately tried to breathe. Yet through all of this, Bruce’s senses were sharp, his mind painfully clear. He knew he was dying. There was a ringing in his ears, a sense of revolving, nausea. Then blackness…

   Pamela Breckenridge had been working from eleven to seven for over a year. It wasn’t a popular shift, but she liked it. She felt it gave her more freedom. During the summer she’d go to the beach by day and sleep in the evenings. In the winter she slept days. Her body had no problem making the adjustment as long as she slept at least seven hours. And as far as her work was concerned, she preferred night duty. There was less hassle. Days sometimes made a nurse feel like a traffic cop, trying to get patients to and from their numerous X rays, EKGs, lab tests, and surgeries. Besides, Pamela liked the responsibility of being alone.
   Tonight as she walked down the empty, darkened corridor all she heard were a few murmurs, the hiss of a respirator, and her own footsteps. It was 3:45. No doctors were immediately on hand, nor even other RNs for that matter. Pamela worked with two LPNs, both skilled veterans of the ward. The three of them had learned to deal with any number of potential catastrophes.
   Passing room 1832, Pamela stopped. During report that evening, the charge nurse going off the shift had mentioned that Bruce Wilkinson’s IV was probably low enough to think about hanging a new bottle of D5W before morning. Pamela hesitated. It was probably a job she should delegate, but since she was right outside the room and no stickler for protocol, she decided to do it herself.
   A wet cough rattled a greeting in the dimly lit room, making Pamela want to clear her own throat. Silently she slipped alongside Wilkinson’s bed. The level of the bottle was low, and she was startled to see the IV running at a very rapid rate. A fresh bottle of D5W was on the nightstand. As she changed the IV and adjusted its rate, she felt something hard under her foot. She looked down and saw the call button. It was only as she bent to retrieve it that she looked at the patient, noticing his face pressed up against the side rail. Something was wrong. Gently she eased Bruce onto his back. Instead of the expected resistance, Bruce flopped over like a rag doll, his right hand coming to rest in a totally unnatural position. She bent closer. The patient was not breathing!
   With trained efficiency, Pamela pressed the call button, switched on the bedside light, and pulled the bed away from the wall. Under the harsh fluorescent light, she saw that Bruce’s skin was a deep grayish blue like a fine Chinese porcelain, suggesting that he had choked on something and had asphyxiated himself. Immediately Pamela bent over, pulled Bruce’s chin back with her left hand, covered his nose with her right hand, and forcefully blew into his mouth. Expecting an airway obstruction, Pamela was surprised when Bruce’s chest rose effortlessly. Obviously if he had choked on something, it was no longer in his trachea.
   She felt Bruce’s wrist for a pulse: nothing. She tried for a carotid pulse: nothing. Taking the pillow from beneath Bruce’s head, she struck his chest with the palm of her hand. Then she bent over and reinflated the lungs.
   The two practical nurses raced into the room at the same time. Pamela said one word, “code,” and they went into action like a crack drill team. Rose quickly had the emergency paged over the loudspeaker while Trudy got the sturdy two-by-three-foot board used for support under a patient during cardiac massage. As soon as Bruce was settled on the board, Rose climbed onto the bed and began to compress his chest. After every fourth compression Pamela reinflated Bruce’s lungs. Meanwhile, Trudy ran for the emergency crash cart and EKG machine.
   Four minutes later when the medical resident, Jerry Donovan, arrived, Pamela, Rose, and Trudy had the EKG machine hooked up and running. Unfortunately it traced a flat, monotonous line. On the positive side, Bruce’s color had improved slightly from its former grayish blue.
   Jerry saw the flat EKG indicating no electrical activity, and, like Pamela, he hit the patient on the chest. No response. He checked the pupils: widely dilated and fixed. Behind Jerry was an intern named Peter Matheson, who climbed up on the bed and relieved Trudy. A disheveled medical student with long hair stood by the door.
   “How long has this been going on?” asked Jerry.
   “It’s been five minutes since I found him,” replied Pamela. “But I have no idea when he arrested. He wasn’t on the monitor. His skin was dark blue.”
   Jerry nodded. For a split second he debated continuing resuscitation. He suspected the patient was already brain dead. But he still hadn’t come to terms with denying treatment. It was easier to go ahead.
   “I want two amps of bicarbonate and some epinephrine,” barked Jerry as he took an endotracheal tube from the crash cart. Stepping behind the bed, he let Pamela inflate the lungs once more. Then he inserted the laryngoscope, an endotracheal tube, and attached an ambu bag, which he connected to the wall oxygen source. Resting his stethoscope on the patient’s chest and telling Peter to hold up for a second, he compressed the ambu bag. Bruce’s chest rose immediately.
   “At least his airway is clear,” said Jerry, as much to himself as anyone.
   The bicarbonate and epinephrine were given.
   “Let’s give him calcium chloride,” said Jerry, watching Bruce’s face slowly turn a normal pink.
   “How much?” asked Trudy, standing behind the crash cart.
   “Five ccs of a ten-percent solution.” Turning back to Pamela he said, “What’s the patient in for?”
   “Bypass surgery,” said Pamela. Rose had brought down the chart and Pamela flipped it open. “He’s four days postop. He’s been doing well.”
   “Was doing well,” corrected Jerry. Bruce’s color looked almost normal but the pupils stayed widely dilated and the EKG ran out a flat line.
   “Must have had a massive heart attack,” said Jerry. “Maybe a pulmonary embolus. Did you say he was blue when you found him?”
   “Dark blue,” Pamela affirmed.
   Jerry shook his head. Neither diagnosis should have produced deep cyanosis. His thoughts were interrupted by the arrival of a surgical resident, groggy with sleep.
   Jerry outlined what he was doing. As he spoke, he held up a syringe of epinephrine to get rid of the air bubbles, then pushed it into Bruce’s chest, perpendicular to the skin. There was an audible snap as the needle broke through some fascia. The only other sound was the EKG machine spewing out paper with the straight line. When Jerry pulled back on the plunger, blood entered the syringe. Confident he was in the heart, Jerry injected. He motioned for Peter to recommence compressing the chest and for Rose to reinflate the lungs.
   Still there was no cardiac activity. As Jerry opened the outer cover of the sterile packaging holding a transvenous pacemaker electrode, he wished he had never begun the charade. Intuitively he knew the patient was too far gone. But now he had started, he had to finish.
   “I’m going to need a fourteen-gauge intercath,” said Jerry. With betadine on a cotton sponge, he began to prepare the entry site on the left side of Bruce’s neck.
   “Would you like me to do that?” asked the surgical resident, speaking for the first time.
   “I think we have it under control,” said Jerry, trying to project more confidence than he felt.
   Pamela began helping him on with a pair of surgical gloves. They were just about to drape the patient when a figure appeared at the doorway and pushed past the medical student. Jerry’s attention was drawn by the surgical resident’s response: the ass-kisser did everything but salute. Even the nurses had perceptively straightened up as Thomas Kingsley, the hospital’s most noted cardiac surgeon, strode into the room.
   He was dressed in scrub clothes, obviously having come directly from the OR. He approached the bed and softly laid a hand on Bruce’s forearm as if through the mere touch he could divine the problem.
   “What are you doing?” he asked Jerry.
   “I’m passing a transvenous pacemaker,” said Jerry, shocked and impressed by Dr. Kingsley’s presence. Staff members usually did not respond to cardiac arrests, especially in the middle of the night.
   “Looks like total cardiac standstill,” said Dr. Kingsley, running a portion of the voluminous EKG tape through his hands. “No evidence of any type of AV block. The chance of a transvenous pacemaker being successful is infinitesimally small. I think you’re wasting your time.” Dr. Kingsley then felt for a pulse at Bruce’s groin. Glancing up at Peter, who was perspiring by this time, Dr. Kingsley said, “Pulse is strong. You must be doing a good job.” Turning to Pamela he said: “Size eights, please.”
   Pamela produced the gloves without delay. Dr. Kingsley pulled them on and asked for the crash cart scalpel.
   “Could you pull off the dressing?” said Dr. Kingsley to Peter. To Pamela he said he needed some sterile heavy dressing scissors.
   Peter glanced at Jerry for confirmation, then paused in his massage, and pulled off the tangle of adhesive and gauze over the patient’s sternum. Dr. Kingsley stepped up to the bed and fingered the scalpel. Without further delay he buried the tip of the knife in the top of the healing wound and decisively drew it down to the base. There was an audible snap as he cut each of the translucent blue nylon sutures. Peter slid off the bed to get out of the way.
   “Scissors,” said Dr. Kingsley calmly as his audience watched in shocked silence. This was the kind of scene they’d read about but had never seen.
   Dr. Kingsley snipped through the wire sutures holding the split sternum together. Then he pushed both hands into the wound and forcibly pulled the sternum apart. There was a sharp cracking noise. Jerry Donovan tried to glance into Bruce’s chest but Dr. Kingsley had obscured the view. The one thing Jerry could tell was that there was no bleeding whatsoever.
   Dr. Kingsley eased his hand, fingers first, into Bruce’s chest and cupped the apex of the heart. Rhythmically he began to compress it, nodding to Rose when she should inflate the lungs. “Check the pulse now,” said Dr. Kingsley.
   Peter dutifully stepped forward. “Strong,” he said.
   “I’d like some epinephrine, please,” said Dr. Kingsley. “But it doesn’t look good. I think this patient arrested some time ago.”
   Jerry Donovan thought about saying he had the same impression but decided against it.
   “Call the EEG lab,” said Dr. Kingsley, continuing to massage the heart. “Let’s see if there’s any brain activity at all.”
   Trudy went to the phone.
   Dr. Kingsley injected the epinephrine but could see that there was no effect on the EKG. “Whose patient is this?” he asked.
   “Dr. Ballantine’s,” said Pamela.
   Bending over, Dr. Kingsley peered into the wound. Jerry guessed he was assessing the surgical repair. It was common hospital knowledge that on a scale of one to ten, as far as operative technique was concerned, Kingsley was a ten, and Ballantine, despite the fact that he was chief of the cardiac surgery department, was about a three.
   Dr. Kingsley abruptly looked up and stared at the medical student as if he’d seen him for the first time. “How can you tell at the moment this isn’t a case of an AV block, Doctor?”
   All color drained from the student’s face. “I don’t know,” he managed finally.
   “Safe answer,” smiled Dr. Kingsley. “I wish I had had the courage to admit not knowing something when I was a medical student.” Turning to Jerry he asked: “What are his pupils doing?”
   Jerry moved over and lifted Bruce’s eyelids. “Haven’t budged.”
   “Run in another amp of bicarbonate,” ordered Dr. Kingsley. “I assume you gave some calcium.”
   Jerry nodded.
   For the next few minutes there was silence as Dr. Kingsley massaged the heart. Then a technician appeared at the doorway with an ancient EEG machine.
   “I just want to know if there’s any electrical activity in the brain,” said Dr. Kingsley. The technician attached the scalp electrodes and turned on the machine. The brain wave tracings were flat, just like the EKG.
   “Unfortunately, that’s that,” said Dr. Kingsley as he withdrew his hand from Bruce’s chest and stripped off his gloves. “I think someone better call Dr. Ballantine. Thank you for your help.” He strode from the room.
   For a moment no one spoke or moved. The EEG technician was first. Self-consciously he said he’d better get back to the lab. He unhooked his paraphernalia and left.
   “I’ve never seen anything like that,” said Peter, staring at Bruce’s gaping chest.
   “Me neither,” agreed Jerry. “Kinda takes your breath away.”
   Both men stepped up to the bed and peered into the wound.
   Jerry cleared his throat. “I don’t know what you need more, competence or self-confidence, to cut into someone like that.”
   “Both,” said Pamela, pulling the plug on the EKG machine. “How about you fellows giving us some room to get this place in order. By the way, one thing I forgot to mention. When I found Mr. Wilkinson, his IV was running rapidly. It should have been barely open.” Pamela shrugged. “I don’t know if it was important or not but I thought I’d let you know.”
   “Thanks,” said Jerry absently. He wasn’t listening. Daintily he stuck his index finger into the wound and touched Bruce’s heart. “People say Dr. Kingsley is an arrogant son of a bitch, but there is one thing I know for sure. If I needed a bypass tomorrow, he is the one I’d have do it.”
   “Amen,” said Pamela, pushing her way between Jerry and the bed to begin preparation of the body.

One

   “There was one new admission last night,” said Cassandra Kingsley, glancing down at her preliminary work-up. She felt distinctly ill at ease, having been thrust into the spotlight of the early morning team meeting on the psychiatry ward, Clarkson Two. “His name is Colonel William Bentworth. He’s a forty-eight-year-old Caucasian male, thrice divorced, who’d been admitted through the ER after an altercation in a gay bar. He was acutely intoxicated and abusive to the ER personnel.”
   “My God!” laughed Jacob Levine, the chief psychiatric resident. He took off his round, wire-rimmed glasses and rubbed his eyes. “Your first night on psychiatry call and you get Bentworth!”
   “Trial by fire,” said Roxane Jefferson, the black, no-nonsense head nurse for Clarkson Two. “No one can say psychiatry at the Boston Memorial is a boring rotation.”
   “He wasn’t my idea of a perfect patient,” admitted Cassi with a weak smile. Jacob’s and Roxane’s comments made her feel a bit more relaxed, sensing that if she made an ass of herself with her presentation, everyone would excuse her. Bentworth was no foreigner to Clarkson Two.
   Cassi had been a psychiatry resident for less than a week. November wasn’t the usual time for people to begin a residency, but Cassi had not decided to switch from pathology to psychiatry until after the beginning of the medical year in July and had only been able to do so because one of the first-year residents had quit. At the time Cassi thought she’d been extraordinarily lucky. But now she wasn’t so sure. Starting a residency without other colleagues equally as inexperienced was more difficult than she’d anticipated. The other first-year residents had almost a five-month jump on her.
   “I bet Bentworth had some choice words for you when you showed up,” sympathized Joan Widiker, a third-year resident who was currently running the psychiatric consultation service and who had taken an immediate liking to Cassi.
   “I wouldn’t want to repeat them,” admitted Cassi, nodding toward Joan. “In fact he refused to talk with me at all, other than to tell me what he thought of psychiatry and psychiatrists. He did ask for a cigarette, which I gave him, thinking it might relax him, but instead of smoking it he proceeded to press the lighted end against his arms. Before I could get some help, he’d burned himself in six places.”
   “He’s a charmer all right,” said Jacob. “Cassi, you should have called me. What time did he come in?”
   “Two-thirty A.M.,” said Cassi.
   “I take that back,” said Jacob. “You did the right thing.”
   Everyone laughed, including Cassi. For once there wasn’t that substratum of hostile competition that had colored all her years of training. And none of the half-respectful, half-jealous commentary that had surrounded her relations at Boston Memorial since her marriage to Thomas Kingsley. Cassi hoped she would be able to repay their support.
   “Anyway,” she said, trying to organize her thoughts. “Mr. Bentworth, or I should say Colonel Bentworth, U.S. Army, presented with acute alcohol intoxication, diffuse anxiety alternating with a depressionlike state, fulminating anger, self-mutilating behavior, and an eight-pound chart of his previous hospitalizations.”
   The group erupted with renewed laughter.
   “One point to Colonel Bentworth’s credit,” said Jacob, “is that he has helped train a generation of psychiatrists.”
   “I had that feeling,” admitted Cassi. “I tried to read the most important parts of the chart. I think it’s about the same length as War and Peace. At least it kept me from making a fool of myself and hazarding a diagnosis. He’s been classified as a borderline personality disorder with occasional brief psychotic states.
   “On physical examination he had multiple contusions on his face and a small laceration of his upper lip. The rest of the physical examination was normal except for his recent self-inflicted burns. There were slight scars across both wrists. He refused to cooperate for a full neurological exam, but he was oriented to time, place, and person. Since the present admission mirrored the last admission in terms of symptoms and since amytal sodium was used on the previous admission with such success, half a gram was given slowly IV.”
   At almost the exact instant that Cassi finished her presentation, her name floated out of the hospital page system. By reflex she started to get up, but Joan restrained her, saying the ward clerk would answer.
   “Did you think Colonel Bentworth was a suicide risk?” asked Jacob.
   “Not really,” said Cassi, knowing she was hedging. Cassi was well aware that her ability to estimate suicide risk was approximately the same as the man in the street’s. “Burning himself with his cigarette was self-mutilating rather than self-destructive.”
   Jacob twirled a lock of his frizzed hair and glanced at Roxane, who had been on Clarkson Two longer than anyone else. She was recognized as an authority of sorts. That was another reason why Cassi enjoyed the psychiatry service. There wasn’t the stiff structure that existed elsewhere in the hospital, with physicians implacably at the top. Doctors, nurses, aides, everyone was part of the Clarkson Two team and respected as such.
   “I’ve tended to ignore the distinction,” said Roxane, “but I suppose there is a difference. Still we should be careful. He’s an extremely complex man.”
   “That’s an understatement,” said Jacob. “The guy had a meteoric rise in the military, especially during his multiple tours of duty in Vietnam. He was even decorated several times, but when I looked into his army record, it always seemed as if a disproportionate number of his own men were killed. His psychiatric problems didn’t seem to show up until he’d reached his present rank of colonel. It was as if success destroyed him.”
   “Getting back to the risk of suicide,” said Roxane, turning to Cassi. “I think the degree of depression is the most important point.”
   “It wasn’t typical depression,” said Cassi, knowing she was venturing out on thin ice. “He said he felt empty rather than sad. One minute he acted depressed and the next he’d erupt with anger and abusive language. He was inconsistent.”
   “There you go,” said Jacob. It was one of his favorite phrases, and its meaning was related to how he stressed the words. In this instance he was pleased. “If you had to pick one word to characterize a borderline patient, I think ‘inconsistency’ would be the most appropriate.”
   Cassi happily absorbed the praise. Her own ego had had very little to feed on during the previous week.
   “Well, then,” said Jacob. “What are your plans for Colonel Bentworth?”
   Cassi’s euphoria vanished.
   Then one of the residents said, “I think Cassi should get him to stop smoking.”
   The group laughed and her tension evaporated.
   “My plans for Colonel Bentworth,” said Cassi, “are…” she paused, “that I’m going to have to do a lot of reading over the weekend.”
   “Fair enough,” said Jacob. “In the meantime I’d recommend a short course of a major tranquilizer. Borderlines don’t do well on extended medication, but it can help them over transient psychotic states. Now then, what else happened last night?”
   Susan Cheaver, one of the psychiatric nurses, took over. With her usual efficiency, Susan summarized all the significant events that had taken place since late afternoon the previous day. The only happening out of the ordinary was an episode of physical abuse suffered by a patient called Maureen Kavenaugh. Her husband had come for one of his infrequent visits. The meeting had seemingly gone well for a while, but then there were angry words followed by a series of vicious openhanded slaps by Mr. Kavenaugh. The episode occurred in the middle of the patient lounge and severely upset the other patients. Mr. Kavenaugh had to be subdued and escorted from the ward. His wife had been sedated.
   “I’ve spoken with the husband on several occasions,” said Roxane. “He’s a truck driver with little or no understanding of his wife’s condition.”
   “And what do you suggest?” asked Jacob.
   “I think,” said Roxane, “that Mr. Kavenaugh should be encouraged to visit his wife but only when someone can be with them. I don’t think Maureen will be able to retain a remission unless he’s brought into the therapy in some capacity, and I think it’s going to be hard to get him to cooperate.”
   Cassi watched and listened as the whole psychiatric team participated. After Susan had finished, each of the residents had an opportunity to discuss their patients. Then the occupational therapist, followed by the psych social worker, had a chance to speak. Finally Dr. Levine asked if there were any other problems. No one moved.
   “Okay,” said Dr. Levine, “see you all at afternoon rounds.”
   Cassi did not get up immediately. She closed her eyes and took a deep breath. The anxiousness engendered by the team meeting had hidden her exhaustion, but now that the excitement was over she felt it with a vengeance. She’d had only three hours of sleep. And for Cassi rest was important. Oh, how nice it would have felt to just lay her head down on her arm right there on the conference table.
   “I bet you’re tired,” said Joan Widiker, placing her hand on Cassi’s arm. It was a warm, reassuring gesture.
   Cassi managed a smile. Joan was genuinely interested in other people. More than anyone, she had taken time to make Cassi’s first week as a psychiatry resident as easy as possible.
   “I’ll make it,” said Cassi. Then she added: “I hope.”
   “You’ll make it fine,” assured Joan. “In fact you did marvelously this morning.”
   “Do you really think so?” asked Cassi. Her hazel eyes brightened.
   “Absolutely,” said Joan. “You even drew a compliment of sorts out of Jacob. He liked your description of Colonel Bentworth as inconsistent.”
   “Don’t remind me,” said Cassi forlornly. “The truth is I wouldn’t know a borderline personality disorder if I met one at dinner.”
   “You probably wouldn’t,” agreed Joan. “Nor would many other people, provided the patient was not having a psychotic episode. Borderlines can be fairly well compensated. Look at Bentworth. He’s a colonel in the army.”
   “That did bother me,” said Cassi. “It didn’t seem to be consistent, either.”
   “Bentworth can upset anyone,” said Joan, giving Cassi’s arm a supportive squeeze. “Come on. I’ll buy you some coffee in the coffee shop. You look like you could use it.”
   “I can use it all right,” agreed Cassi. “But I’m not sure I should take the time.”
   “Doctor’s orders,” said Joan, getting up. As they walked down the corridor, she added, “I got Bentworth when I was a first-year resident, and I had the same experience as you did. So I know how you feel.”
   “No kidding,” said Cassi, encouraged. “I didn’t want to admit it at the meeting, but I found the colonel frightening.”
   Joan nodded. “Look, Bentworth’s trouble. He’s vicious, and he’s smart. Somehow he knows just how to get at people: find their weaknesses. That power, combined with his pent-up anger and hostility, can be devastating.”
   “He made me feel completely worthless,” said Cassi.
   “As a psychiatrist,” corrected Joan.
   “As a psychiatrist,” agreed Cassi. “But that’s what I’m supposed to be. Maybe if I could find some similar case histories to read.”
   “There is plenty of literature,” said Joan. “Too much. But it’s a little like learning to ride a bike. You could read everything about bicycles, for years, yet when you finally tried to ride it yourself, you wouldn’t be able to. Psychiatry is as much a process as it is knowledge. Come on, let’s get that coffee.”
   Cassi hesitated. “Maybe I should get to work.”
   “You don’t have any scheduled patient meetings right now, do you?” asked Joan.
   “No, but…”
   “Then you’re coming.” Joan took her arm and they started walking again.
   Cassi allowed herself to be led. She wanted to spend a little time with Joan. It was encouraging as well as instructive. Maybe Bentworth would be willing to talk after a night’s rest.

   “Let me tell you something about Bentworth,” said Joan, as if reading Cassi’s mind. “Everyone that I know who has taken care of him, myself included, was certain they would cure him. But borderlines in general and Colonel Bentworth in particular don’t get cured. They can get progressively better compensated but not cured.”
   As they passed the nurses’ station, Cassi left Bentworth’s chart and asked about her page. “It was Dr. Robert Seibert,” said the aide. “He asked for you to call as soon as possible.”
   “Who’s Dr. Seibert?” asked Joan.
   “He’s a resident in pathology,” answered Cassi.
   “As soon as possible sounds like you’d better call,” said Joan.
   “Do you mind?”
   Joan shook her head, and Cassi went around the counter to use the phone next to the chart rack. Roxane came over to Joan. “She’s a nice kid,” the nurse said. “I think she’s going to be a real addition around here.” Joan nodded, and they both agreed that Cassi’s insecurity and anxiety were a function of her commitment and dedication.
   “But she worries me a little,” added Roxane. “She seems to have a special vulnerability.”
   “I think she’ll be fine,” said Joan. “And she can’t be too weak being married to Thomas Kingsley.”
   Roxane grinned and walked down the hall. She was a tall, elegant black woman who commanded respect for her intellect and sense of style. She’d worn her hair braided in corn rows long before it was fashionable.
   As Cassi put down the phone, Joan eyed her carefully. Roxane was right. Cassi did seem delicate. Perhaps it was her pale, almost translucent skin. She was slender but graceful, only slightly over five-feet-two. Her hair was fine and varied in color from a shiny walnut to blond depending upon the angle and the light. At work she wore it loosely piled on her head, held in place with small combs and hairpins. But because of its texture, wisps spilled down around her face in gossamer strands. Her features were small and narrow, and her eyes turned up ever so slightly at the outer corners, giving them a mildly exotic appearance. She wore little makeup, which made her look younger than her twenty-eight years. Her clothes were always neat even if she’d been up most of the night, and today she was dressed in one of her many high-necked white blouses. To Joan, Cassi appeared like a young woman in an old Victorian photograph.
   “Instead of going for coffee,” said Cassi with enthusiasm, “how about coming with me to pathology for a few minutes?”
   “Pathology,” said Joan, with some reluctance.
   “I’m sure we can get coffee up there,” said Cassi, as if that was the explanation of Joan’s hesitation. “Come on. You might find it interesting.”
   Joan allowed herself to be led down the main corridor to the heavy fire door which led into the hospital proper. There were no locked doors on Clarkson Two. It was an “open” ward. Many of the patients were not allowed to leave the floor, but compliance was up to them. They knew if they ignored the rules they risked being sent to the State Hospital. There the environment was significantly different and much less pleasant.
   As the door closed behind her, Cassi felt a sense of relief. In sharp contrast to the psychiatry ward, here in the main hospital building it was easy to distinguish the doctors and nurses from the patients. The doctors wore either suit jackets or their white coats; the nurses, their white uniforms; and the patients, their hospital johnnies. Back in Clarkson Two everyone wore street clothes.
   As Cassi and Joan threaded their way toward the central elevators, Joan asked, “What was it like being a resident in pathology? Did you like it?”
   “I loved it,” said Cassi.
   “I hope you don’t take this as an insult,” laughed Joan. “But you don’t look like any pathologist I know.”
   “It’s the story of my life,” said Cassi. “First nobody would believe I was a medical student, then they said I looked too young to be a doctor, and last night Colonel Bentworth was kind enough to tell me I didn’t look like a psychiatrist. What do you think I look like?”
   Joan didn’t answer. The truth was Cassi looked more like a dancer or a model than a doctor.
   They joined the crowd of people in front of the bank of elevators serving Scherington, the main hospital building. There were only six elevators, which turned out to be an architectural blunder. Sometimes you could wait ten minutes for a car and then have to stop at every floor.
   “What made you switch residencies?” asked Joan. As soon as the question left her lips, she regretted it. “You don’t have to answer that. I don’t mean to pry. I guess it’s the psychiatrist in me.”
   “It’s quite all right,” said Cassi equably. “And actually it’s quite simple. I have juvenile diabetes. In choosing my medical specialty, I’ve had to keep that reality in mind. I’ve tried to ignore it, but it is a definite handicap.”
   Joan’s embarrassment was increased by Cassi’s candor. Yet as uncomfortable as Joan felt, she thought it would be worse not to respond to Cassi’s honesty. “I would have thought under the circumstances pathology would have been a good choice.”
   “I thought so too, at first,” said Cassi. “But unfortunately during the past year I began to have trouble with my eyes. In fact, at the moment I can only distinguish light and dark with my left eye. I’m sure you know all about diabetic retinopathy. I’m not a defeatist but if worse comes to worst, I could practice psychiatry even if I became blind. Not so with pathology. Come on, let’s get that first elevator.”
   Cassi and Joan were swept into the car. The door closed, and they started up.
   Joan had not felt so uncomfortable in years, but she felt she had to respond. “How long have you had diabetes?” she asked.
   The simple question hurled Cassi back in time. Back to when she was eight and her life began to change. Up to that point, Cassi had always liked school. She was an eager, enthusiastic child who seemed to look forward to new experiences. But in the middle of the third grade it all changed. In the past she’d always been ready for school early; now she had to be pushed and cajoled by her mother. Her concentration dwindled and notes to that effect began to arrive from her teacher. One of the central issues, something that no one recognized, not even Cassi herself, was that Cassi had to use the girls’ room more and more frequently. After a time the teacher, Miss Rossi, began on occasion to refuse Cassi’s requests, suspecting that she was using trips to the toilet to avoid her work. When this happened, Cassi experienced the awful fear that she would lose control of her bladder. In her mind’s eye she could picture what it would look like if she had “an accident,” and her urine dripped down from her seat and puddled under her desk. The fear brought on anger and the anger, ostracism. The kids began to make fun of Cassi.
   At home an episode of bedwetting surprised and shocked both Cassandra and her mother. Mrs. Cassidy demanded an explanation, but Cassandra had none and was, in fact, equally appalled. When Mr. Cassidy suggested they consult the family doctor, Mrs. Cassidy was too mortified to do so, convinced as she was that the whole affair was a behavioral disorder.
   Various punishments had no effect. If anything they exacerbated the problem. Cassi began to throw temper tantrums, lost her few remaining friends, and spent most of her time in her room. Mrs. Cassidy reluctantly began to think about the need for a child psychologist.
   Things came to a head in the early spring. Cassi could remember the day vividly. Only a half hour after a recess, she began to experience a combination of mounting bladder pressure and thirst. Anticipating Miss Rossi’s response so close to recess, Cassi tried vainly to wait for class to end. She squirmed in her seat and clutched her hands into tight fists. Her mouth became so dry she could barely swallow, and despite all her efforts, she felt the release of a small amount of urine.
   In terror she walked pigeon-toed up to Miss Rossi and asked to be excused. Miss Rossi, without a glance, told her to take her seat. Cassi turned and walked deliberately to the door. Miss Rossi heard it open and looked up.
   Cassi fled to the he girls’ room with Miss Rossi at her heels. She had her panties down and her dress bunched in her arms before Miss Rossi caught up to her. With relief, the little girl sank onto the toilet. Miss Rossi stood her ground, putting her hands on her hips, and waited with an expression that said: “You’d better produce or else…”
   Cassi produced. She began to urinate and continued for what seemed like an incredible duration of time. Miss Rossi’s angry expression mellowed. “Why didn’t you go during recess?” she demanded. “I did,” said Cassi plaintively.
   “I don’t believe you,” said Miss Rossi. “I just don’t believe you, and this afternoon after school, we are going to march down to Mr. Jankowski’s office.”
   Back in the classroom, Miss Rossi made Cassi sit by herself. She could still remember the dizziness that came over her. First she couldn’t see the blackboard. Then she felt strange all over and thought she was going to vomit. But she didn’t. Instead she passed out. The next thing Cassi knew was that she was in the hospital. Her mother was bending over her. She told Cassi she had diabetes.
   Cassi turned to Joan, bringing her mind back to the present.
   “I was hospitalized when I was nine,” said Cassi hurriedly, hoping Joan hadn’t noticed the fact that she had been daydreaming. “The diagnosis was made then.”
   “That must have been a difficult time for you,” said Joan.
   “It wasn’t so bad,” said Cassi. “In some respects it was a relief to know that the symptoms I had been having had a physical basis. And once the doctors stabilized my insulin requirements, I felt much better. By the time I reached my teens I even got used to giving myself the injections twice a day. Ah, here we are.” Cassi motioned them off the elevator.
   “I’m impressed,” said Joan with sincerity. “I doubt if I’d have been able to handle my medical training if I had had diabetes.”
   “I’m certain you would have,” said Cassi casually. “We’re all more adaptable than we give ourselves credit for.”
   Joan wasn’t sure she agreed, but she let it go. “What about your husband? Having known a few surgeons in my life, I hope he’s understanding and supportive.”
   “Oh, he is,” said Cassi, but she answered too quickly for Joan’s analytical mind.
   Pathology was its own world, completely separate from the rest of the hospital. As a psychiatric resident, Joan hadn’t visited the floor in the two years she’d been at Boston Memorial. She had prepared herself for the dark, nineteenth-century appearance of the department of pathology in her medical school, complete with dingy glass-fronted cabinets filled with round specimen jars containing bits of horror in yellowing Formalin. Instead, she found herself in a white, futuristic world composed of tile, Formica, stainless steel, and glass. There were no specimens and no clutter and no strangely repulsive smells. At the entrance there were a number of secretaries with earphones typing onto word-processing screens. To the left were offices, and down the center was a long white Formica table supporting double-headed microscopes.
   Cassi led Joan into the first office where an impeccably dressed young man leaped up from his desk and greeted Cassi with a big, unprofessional hug. Then the man thrust Cassi away so he could look at her.
   “God, you look good,” he said. “But wait. You haven’t colored your hair, have you?”
   “I knew you’d notice,” laughed Cassi. “No one else has.”
   “Of course I’d notice. And this is a new blouse. Lord and Taylor?”
   “No, Saks.”
   “It’s wonderful.” He fingered the material. “It’s all cotton. Very nice.”
   “Oh, I’m sorry!” said Cassi, remembering Joan and introducing her. “Joan Widiker, Robert Seibert, second-year pathology resident.”
   Joan took Robert’s outstretched hand. She liked his engaging, forthright smile. His eyes twinkled, and Joan had the feeling she’d been instantly inspected.
   “Robert and I went to the same medical school,” explained Cassi as Robert put his arm around her again. “And then by chance we both ended up here at the Boston Memorial for first-year pathology.”
   “You two look like you could be brother and sister,” said Joan.
   “People have said that,” said Robert, obviously pleased. “We had an immediate affinity for each other for a lot of reasons including the fact that we both had serious childhood diseases. Cassi had diabetes, and I had rheumatic fever.”
   “And we’re both terrified of surgery,” said Cassi, causing herself and Robert to burst out laughing.
   Joan assumed it was some kind of private joke.
   “Actually, it’s not so funny,” said Cassi. “Instead of mutually supporting each other, we’ve ended up making each other more scared. Robert is supposed to have his wisdom teeth removed, and I’m supposed to have the hemorrhage in my left eye cleared.”
   “I’m going to have mine taken care of soon,” said Robert defiantly. “Now that I’ve got you out of my hair.”
   “I’ll believe that when it happens,” laughed Cassi.
   “You’ll see,” said Robert. “But meanwhile let’s get down to business. I’ve saved the autopsy until you got here. But first I promised to call the medical resident who tried to resuscitate the patient.”
   Robert stepped back to his desk and picked up his phone.
   “Autopsy!” Joan whispered, alarmed. “I didn’t bargain on an autopsy. I’m not sure I’m up for that.”
   “It might be worthwhile,” said Cassi innocently, as if watching an autopsy was something people did for amusement. “During my time as a pathology resident, Robert and I became interested in a series of cases that we’ve labeled SSD, for sudden surgical death. What we found was a group of cardiac surgery patients who had died less than a week after their operations even though most had been doing well and who, on autopsy, had no anatomical cause of death. A few might be understandable, but counting what turned up in the records for the last ten years, we found seventeen. The case Robert is going to autopsy now could make eighteen.”
   Robert returned from the phone saying Jerry Donovan would be right down and offered his guests coffee. Before they had a chance to drink it, Jerry arrived on the run. The first thing he did was give Cassi a hug. Joan was impressed. Cassi seemed to be on friendly terms with everyone. Then he slapped Robert on the shoulder and said, “Hey, man, thanks for the call.”
   Robert winced at the impact of the blow and forced a smile.
   To Joan, Jerry was dressed like the usual house officer. His white jacket, rumpled and soiled, hung askew due to the weight of an overstuffed black notebook in the right pocket. His pants were spotted with a line of bloodstains across the thighs. Next to Robert, Jerry looked like a floor sweeper in a meat-packing house.
   “Jerry went to the same medical school as Robert and I,” explained Cassi. “Only he was an upper classman.”
   “A distinction that is still painfully obvious,” kidded Jerry.
   “Let’s go,” said Robert. “I’ve had one of the autopsy rooms on hold long enough.”
   Robert left first, followed by Joan. Jerry stepped aside for Cassi, then caught up to her.
   “You’ll never guess who I had the pleasure of watching do his thing last night,” said Jerry as they skirted the microscope table.
   “I wouldn’t even try,” said Cassi, expecting some off-color humor.
   “Your husband! Dr. Thomas Kingsley.”
   “Really?” said Cassi. “What was a medicine man like you doing in the OR?”
   “I wasn’t,” said Jerry. “I was on the surgical floor trying to resuscitate the patient we’re going to autopsy. Your husband responded to the code. I was impressed. I don’t think I’ve ever seen such decisiveness. He ripped this guy’s chest open and gave open-heart massage right on the bed. It blew my mind. Tell me, is your husband that impressive at home?”
   Cassi shot Jerry a harsh glance. If that comment had come from anybody but Jerry, she probably would have snapped back. But she expected off-color humor and there it was. So why make an issue? She decided to let it drop.
   Ignoring Cassi’s less-than-positive reaction, Jerry continued: “The thing that impressed me was not the actual cutting open of the guy’s chest but rather the decision to do it in the first place. It’s so goddamn irreversible. It’s a decision I don’t know how anybody could make. I agonize over whether or not to start a patient on antibiotics.”
   “Surgeons get used to that sort of thing,” said Cassi. “That kind of decision making becomes a tonic. In a sense they enjoy it.”
   “Enjoy it?” echoed Jerry with disbelief. “That’s pretty hard to believe, but I suppose they must; otherwise we wouldn’t have any surgeons. Maybe the biggest difference between an internist and a surgeon is the ability to make irreversible decisions.”
   Entering the autopsy room, Robert donned a black rubber apron and rubber gloves. The others grouped around the pale corpse whose chest still gaped open. The edges of the wound had darkened and dried. Except for an endotracheal tube that stuck rudely out of the mouth, the patient’s face looked serene. The eyes were thankfully closed.
   “Ten to one it was a pulmonary embolism,” said Jerry confidently.
   “I’ll put a dollar on that,” said Robert, positioning a microphone which hung from the ceiling at a convenient height. It was operated by a foot pedal. “You told me yourself the patient initially had been very cyanotic. I don’t think we’re going to find an embolism. In fact, if my hunch is correct, we’re not going to find anything.”
   As Robert began his examination, he started dictating into the mike. “This is a well-developed, well-nourished Caucasian male weighing approximately one hundred sixty-five pounds and measuring seventy inches in length who appears to be of the stated age of forty-two…”
   As Robert went on to describe the other visible evidence of Bruce Wilkinson’s surgery, Joan stared at Cassi, who was placidly sipping her coffee. Joan looked down at her own cup. The idea of drinking it made her stomach turn.
   “Have all these SSD cases been the same?” asked Joan, trying not to look at the table where Robert was arranging scalpels, scissors, and bone clippers in preparation of opening and eviscerating the corpse.

   Cassi shook her head. “No. Some have been cyanotic like this case, some seemed to have died from cardiac arrest, some from respiratory failure, and some from convulsions.”
   Robert began the usual Y-shaped autopsy incision, starting high on the shoulder and connecting with the open-chest incision. Joan could hear the blade scrape across the underlying bony structures.
   “What about the kind of surgery?” asked Joan. She heard ribs crack and closed her eyes.
   “They’ve all had open-heart surgery but not necessarily for the same condition. We’ve checked anesthesia, duration of pump time, whether or not hypothermia was used. There were no correlations. That’s been the frustrating part.”
   “Well, why are you trying to relate them?”
   “That’s a good question,” said Cassi. “It has to do with the mentality of a pathologist. After you’ve done an autopsy, it’s very unsatisfying not to have a definitive cause of death. And when you have a series of such cases, it’s demoralizing. Solving the puzzle is what makes pathology rewarding.”
   Involuntarily Joan’s eyes stole a quick glance at the table. Bruce Wilkinson appeared as if he’d been unzipped. The skin and subcutaneous structures of the chest and thorax had been folded back like the leaves of a gigantic book. Joan felt herself swaying.
   “The knowledge is important,” Cassi went on, unaware of Joan’s difficulties. “It can have a direct benefit to future patients if some preventable cause is discovered. And in this situation, we’ve noticed an alarming trend. The initial patients seemed to have been older and much sicker. In fact, most were in irreversible coma. Lately though, the patients have been under fifty and generally healthier, like Mr. Wilkinson here. Joan, what’s the matter?” Cassi had turned and finally noticed that her friend seemed about to faint.
   “I’m going to wait outside,” said Joan. She turned and started for the door, but Cassi caught her arm.
   “Are you all right?” asked Cassi.
   “I’ll be fine,” said Joan. “I just need to sit down.” She fled through the stainless steel door.
   Cassi was about to follow when Robert called for her to look at something. He pointed at a quarter-sized contusion on the surface of the heart.
   “What do you think of that?” asked Robert.
   “Probably from the resuscitation attempt,” said Cassi.
   “At least we agree on that,” said Robert as he directed his attention back to the respiratory system and the larynx. Deftly he opened the breathing passages. “No obstruction of any sort. If there had been, that would have explained the deep cyanosis.”
   Jerry grunted and said, “Goin’ to be pulmonary embolism. I’m sure of it.”
   “It’s a bad bet,” said Robert, shaking his head.
   Switching his attention lower, Robert examined the main pulmonary vessels and the heart itself. “These are the bypass vessels sewn in place.” He leaned back so Cassi and Jerry could take a look.
   Hefting a scalpel, Robert said: “Okay, Dr. Donovan. Better put your money on the table.” Robert bent over and opened the pulmonary arteries. There were no clots. Next he opened the right atrium of the heart. Again the blood was liquid. Finally he turned to the vena cava. There was a bit of tension as the knife slipped into the vessels, but they too were clear. There were no emboli.
   “Crap!” said Jerry in disgust.
   “That’s ten dollars you owe me,” said Robert smugly.
   “What the hell could have bumped this guy off?” asked Jerry.
   “I don’t think we’re going to find out,” said Robert. “I think we’ve got number eighteen here.”
   “If we are going to find anything,” said Cassi, “it will be inside the head.”
   “How do you figure?” asked Jerry.
   “If the patient was really cyanotic,” said Cassi, “and we haven’t found a right-to-left circulatory shunt, then the problem has to be in the brain. The patient stopped breathing, but the heart kept pumping unoxygenated blood. Thus cyanosis.”
   “What’s that old saying?” said Jerry. “Pathologists know everything and do everything but too late.”
   “You forgot the first part,” said Cassi. “Surgeons know nothing but do everything. Internists know everything but do nothing. Then comes the part about pathologists.”
   “And what about psychiatrists?” asked Robert.
   “That’s easy,” laughed Jerry. “Psychiatrists know nothing and do nothing!”
   Quickly Robert finished the autopsy. The brain appeared normal on close examination. No sign of clot or other trauma.
   “Well?” asked Jerry, staring at the glistening convolution of Bruce’s brain. “Do you two hotshots have any other bright ideas?”
   “Not really,” said Cassi. “Maybe Robert will find evidence of a heart attack.”
   “Even if I do,” said Robert, “it wouldn’t explain the cyanosis.”
   “That’s true,” said Jerry, as he scratched the side of his head. “Maybe the nurse was wrong. Maybe the guy was just ashen.”
   “Those nurses on cardiac surgery are awfully competent,” said Cassi. “If they said the patient was dark blue, he was dark blue.”
   “Then I give up,” said Jerry, taking out a ten-dollar bill and slipping it into the pocket of Robert’s white jacket.
   “You don’t have to pay me,” said Robert. “I was just kidding.”
   “Bullshit,” said Jerry. “If it had been a pulmonary embolism I’d have taken your money.” Jerry walked over to where he’d hung his white jacket.
   “Congratulations, Robert,” said Cassi. “Looks like you got case number eighteen. Compared to the number of open-heart surgery cases they’ve done over the last ten years, that’s getting close to being statistically significant. You’ll get a paper out of this yet.”
   “What do you mean ‘me’?” asked Robert. “You mean ‘us,’ don’t you?”
   Cassi shook her head. “No, Robert. This whole thing has been your idea from the start. Besides, now that I’ve switched to psychiatry, I can’t hold up my end of the work.”
   Robert looked glum.
   “Cheer up,” said Cassi. “When the paper comes out, you’ll be glad you didn’t have to share authorship with a psychiatrist.”
   “I was hoping this study would get you to come up here frequently.”
   “Don’t be silly,” said Cassi. “I’ll still come up, especially when you find new SSD cases.”
   “Cassi, let’s go,” called Jerry impatiently. He had the door held open with his foot.
   Cassi gave Robert a peck on the cheek and ran out. Jerry took a playful swipe at her as she passed through the door. Not only did she evade the blow, but she managed to give Jerry’s necktie a sharp tug as she passed.
   “Where’s your woman friend?” asked Jerry as they reached the main part of the pathology department. He was still struggling to straighten his tie.
   “Probably in Robert’s office,” said Cassi. “She said she needed to sit down. I think the autopsy was a little much for her.”
   Joan had been resting with her eyes closed. When she heard Cassi she got unsteadily to her feet. “Well, what did you learn?” She tried to sound casual.
   “Not much,” said Cassi. “Joan, are you all right?”
   “Just a mortal wound to my pride,” said Joan. “I should have known better than watch an autopsy.”
   “I’m terribly sorry…” began Cassi.
   “Don’t be silly,” said Joan. “I came voluntarily. But I’d just as soon leave if you’re ready.”
   They walked down to the elevators where Jerry decided to use the stairs since it was only four flights to the medical floor. He waved before disappearing into the stairwell.
   “Joan,” said Cassi, turning back to her. “I really am sorry I forced you up here. I’d gotten so accustomed to autopsies as a path resident that I’d forgotten how awful they can be. I hope it didn’t upset you too much.”
   “You didn’t force me up here,” said Joan. “Besides, my squeamishness is my problem, not yours. It’s just plain embarrassing. You’d think after four years of medical school I’d have gotten over it. Anyway, I should have admitted it and waited for you in Robert’s office. Instead I acted like a fool. I don’t know what I was trying to prove.”
   “Autopsies were hard for me at first,” said Cassi, “but gradually it became easier. It is astounding what you can get used to if you do it enough, especially when you can intellectualize it.”
   “For sure,” said Joan, eager to change the subject. “By the way, your men friends do run the gamut. What’s the story with Jerry Donovan? Is he available?”
   “I think so,” said Cassi, punching the elevator button again. “He was married back in med school but then divorced.”
   “I know the story,” said Joan.
   “I’m not sure if he’s dating anyone in particular,” said Cassi. “But I could find out. Are you interested?”
   “I wouldn’t mind asking him to dinner,” said Joan pensively. “But only if I could be sure he’d put out on the first date.”
   It took a moment for Joan’s comment to penetrate before Cassi burst out laughing. “I think you sized him up pretty well,” she said.
   “The macho medicine man,” said Joan. “What about Robert?” Joan lowered her voice as they got on the elevator. “Is he gay?”
   “I suppose so,” said Cassi. “But we’ve never discussed it. He’s been such a good friend, it has never mattered. He used to rate my boyfriends back in medical school, and I used to listen until I met my husband because Robert was always right. But he must have been jealous of Thomas because he never liked him.”
   “Does he still feel that way?” asked Joan.
   “I can’t say,” said Cassi. “That’s the only other subject that we never talk about.”

Two

   “The patient is ready for you in No. 3 cardiac cath room,” said one of the X-ray technicians. She didn’t come into the office but rather just stuck her head around the door. By the time Dr. Joseph Riggin turned to acknowledge the information, the girl was gone.
   With a sigh, Joseph lifted his feet off his desk, tossed the journal he’d been reading onto the bookshelf, and took one last slug of coffee. From a hook behind the door he lifted his lead apron and put it on.
   The radiology corridor at 10:30 A.M. reminded Joseph of a sale day at Bloomingdale’s. There were people everywhere waiting in chairs, waiting in lines, and waiting on gurneys. Their faces had a blank, expectant look. Joseph felt an unwelcome sense of boredom. He’d been doing radiology now for fourteen years and he was beginning to admit to himself that the excitement had gone out of it. Every day was like every other day. Nothing unique ever happened anymore. If it hadn’t been for the arrival of the CAT scanner a number of years ago, Joseph wondered if he’d have quit. As he pushed into No. 3, he tried to imagine what he could do if he left clinical radiology. Unfortunately he didn’t have any bright ideas.
   The No. 3 cath room was the largest of the five rooms so equipped. It had the newest equipment as well as its own built-in viewer screens. As Joseph entered, he saw that someone else’s X rays had been left up. If he’d told his technicians once, he’d told them a thousand times that he wanted his room cleared of previous films before he did a study. Then, as if that wasn’t enough, Joseph noticed there was no technician.
   Joseph felt his blood pressure soar. It was a cardinal rule that no patients were ever to be left unattended, “Dammit,” snarled Joseph under his breath. The patient was lying on the X-ray table, covered by a thin white blanket. He looked about fifteen years old, with a broad face and close-cropped hair. His dark eyes were watching Joseph intently. Next to the table was an IV bottle, and the plastic tube snaked under the blanket.
   “Hello,” said Joseph, forcing a smile despite his frustration.
   The patient did not stir. As Joseph took the chart, he noticed that the boy’s neck was thick and muscular. Another glance at the boy’s face suggested that this was no ordinary patient. His eyes were abnormally tilted and his tongue, which partially protruded from his lips, was enormous.
   “Well, what do we have here?” said Joseph with a wave of uneasiness. He wished the boy would say something or at least look away. Joseph flipped open the chart and read the admitting note.
   “Sam Stevens is a twenty-two-year-old muscular Caucasian male institutionalized since age four with undiagnosed mental retardation, who is admitted for definitive work-up and repair of his congenital cardiac abnormality thought to be a septal defect…”
   The door to the cath room banged open, and Sally Marcheson breezed in carrying a stack of cassettes. “Hi, Dr. Riggin,” she called.
   “Why has this patient been left alone?”
   Sally stopped short of the X-ray machine. “Alone?”
   “Alone,” repeated Joseph with obvious anger.
   “Where’s Gloria? She was supposed…”
   “For Christ’s sake, Sally,” shouted Joseph. “Patients are never to be left alone. Can’t you understand that?”
   Sally shrugged. “I’ve only been gone fifteen or twenty minutes.”
   “And what about all these X rays? Why are they out?”
   Sally glanced at the viewers. “I don’t know anything about them. They weren’t here when I left.”
   Quickly Sally began pulling the X rays down and stuffing them in the envelope on the countertop. It was someone’s coronary angiogram, and she had no idea whatsoever why the X rays were there.
   Still grumbling to himself, Joseph opened a sterile gown and pulled it on. Glancing back at the patient, he saw that the boy had not moved. His eyes still followed him wherever he moved.
   With a frightful banging noise, Sally succeeded in loading the cassettes into the machine, then came back to pull off the sterile cover over the cath tray.
   While Joseph pulled on rubber gloves, he moved over closer to the patient’s face. “How are you doing, Sam?” For some reason, knowing the boy was retarded made Joseph think he should speak louder than usual. But Sam didn’t respond.
   “Do you feel okay, Sam?” called Joseph. “I’m going to have to stick you with a little needle, okay?”
   Sam acted as if he were carved from granite.
   “I want you to stay very still, okay?” persisted Joseph.
   True to form, Sam didn’t budge. Joseph was about to return his attention to the cath tray when Sam’s tongue once again caught his attention. The protruding portion was cracked and dried. Looking closer, Joseph could see that Sam’s lips weren’t much better off. The boy looked like he’d been wandering around in a desert.
   “You a little thirsty, Sam?” queried Joseph.
   Joseph glanced up at the IV, noticing that it wasn’t running. With a flick of his wrist he turned it on. No sense in the kid becoming dehydrated.
   Joseph stepped over to the cath tray and took the gauze out of the prep dishes.
   A high-pitched, inhuman scream shattered the stillness of the cath room. Joseph whirled around, his heart in his mouth.
   Sam had thrown off his blanket and was clawing at the arm that had the IV. His feet began to hammer up and down on the X-ray table. A shrill cry still issued from his lips.
   Joseph collected himself enough to pull the fluoroscopy unit back away from Sam’s thrashing legs. He reached up and put his hands on Sam’s shoulders to push him back onto the table. Instead Sam grasped Joseph’s arm with such power that Joseph yelped out in pain. Powerless to prevent it, Joseph watched with horror as Sam pulled Joseph’s hand up to his mouth, then sank his teeth into the base of Joseph’s thumb.
   It was now Joseph’s turn to scream. He struggled to pull his arm from Sam’s grasp, but the boy was far too strong. In desperation Joseph lifted a foot to the side of the X-ray table and pushed. He stumbled back and fell, pulling Sam on top of him.
   Joseph felt Sam release his arm only to feel the boy’s hands close around his throat. Pressure built up inside of his head as the boy squeezed. Desperately he tried to pull Sam’s hands away, but they were like steel. The room began to spin. With a last reserve of strength, Joseph brought his knee up into the boy’s groin.
   Almost simultaneously, Sam’s body heaved with a sudden contraction. It was rapidly followed by another and then another. Sam was having a grand mal seizure, and Joseph lay pinned to the floor beneath the heaving, convulsing body.
   Sally finally recovered from shock and helped Joseph squirm free. Sam’s eyes had disappeared up inside his head and blood sprayed in a gradually widening circle from his mangled tongue
   “Get help,” gasped Joseph as he grasped his own wrist to stem the bleeding. Within the jagged edges of the wound he could see the glistening surface of exposed bone.
   Before help arrived, Sam’s wrenching spasms weakened and all but stopped. By the time Joseph realized the boy was not breathing, the medical emergency team arrived. They worked feverishly but to no avail. After fifteen minutes, a reluctant Dr. Joseph Riggin was led away to have his hand sutured while Sally Marcheson removed the misplaced X rays.

   As Thomas Kingsley scrubbed, he felt the surge of excitement that always possessed him before an operation. He had known he was born to be a surgeon the first time he’d assisted in the OR as an intern, and it hadn’t been long before his skill had been acknowledged throughout the hospital. Now as Boston Memorial’s foremost cardiovascular surgeon, he had an international reputation.
   Rinsing off the suds, Thomas lifted his hands to prevent water from running down his arms. He opened the OR door with his hip. As he did so, he could hear the conversation in the room trail off into awed silence. He accepted a towel from the scrub nurse, Teresa Goldberg. For a second their eyes met above their face masks. Thomas liked Teresa. She had a wonderful body that even the bulky surgical gown she was wearing could not hide. Besides, he could yell at her if need be, knowing she wouldn’t burst into tears. She was also smart enough not only to recognize that Thomas was the best surgeon at the Memorial but to tell him so.
   Thomas methodically dried his hands while he checked out the patient’s vital signs. Then, like a general reviewing his troops, he moved around the room, nodding to Phil Baxter, the perfusionist, who stood behind his heart-lung machine. It was primed and humming, ready to take over the job of oxygenating the patient’s blood and pumping it around the body while Thomas did his work.
   Next Thomas eyed Terence Halainen, the anesthesiologist.
   “Everything is stable,” said Terence, alternately squeezing the breathing bag.
   “Good,” said Thomas.
   Disposing of the towel, Thomas slipped on the sterile gown held by Teresa. Then he thrust his hands into special brown rubber gloves. As if on cue, Dr. Larry Owen, the senior cardiac surgery fellow, looked up from the operative field.
   “Mr. Campbell is all ready for you,” said Larry, making room for Thomas to approach the OR table. The patient lay with his chest fully opened in preparation for the famous Dr. Kingsley to do a bypass procedure. At Boston Memorial it was customary for the senior resident or fellow to open as well as close such operations.
   Thomas stepped up to his position on the patient’s right. As he always did at this point, he slowly reached into the wound and touched the beating heart. The wet surface of his rubber gloves offered no resistance, and he could feel all the mysterious movement in the pulsating organ.
   The touch of the beating heart took Thomas’s mind back to his first major case as a resident in thoracic surgery. He had been involved in many operations prior to that, but always as the first assistant, or second assistant, or somewhere down the line of authority. Then a patient named Walter Nazzaro had been admitted to the hospital. Nazzaro had had a massive heart attack and was not expected to live. But he did. Not only did he survive his heart attack, but he survived the rigorous evaluation that the house staff doctors put him through. The results of the work-up were impressive. Everyone wondered how Walter Nazzaro had lived as long as he had. He had occlusive disease in his main left coronary artery, which had been responsible for his heart attack. He also had occlusive disease in his right coronary artery with evidence of an old heart attack. In addition he had mitral and aortic valve disease. Then, as if that weren’t enough, Walter had developed an aneurysm, or a ballooning of the wall, of his left ventricle of his heart as a result of the most recent heart attack. He also had an irregular heart rhythm, high blood pressure, and kidney disease.
   Since Walter was such a fund of anatomic and physiologic pathology, he was presented at all the conferences with everyone offering various opinions. The only aspect of his case that everyone agreed upon was the fact that Walter was a walking time bomb. No one wanted to operate except a resident named Thomas Kingsley, who argued that surgery was Walter’s only chance to escape the death sentence. Thomas continued to argue until everyone was sick of hearing him. Finally the chief resident agreed to allow Thomas to do the case.
   On the day of surgery, Thomas, who had been working with an experimental method of aiding cardiac function, inserted a helium-driven counterpulsation balloon into Walter’s aorta. Anticipating trouble with Walter’s left ventricle, Thomas wanted to be prepared. Only after the operation had begun did the reality of the situation dawn on him. Excitement had changed to anxiety as Thomas began to follow the plan he had outlined in his mind. He would never forget the sensation he experienced when he stopped Walter’s heart and held the quivering mass of sick muscle in his mind. At that moment he knew it was in his power to restore life. Refusing to consider the possibility of failure, Thomas first performed a bypass, an experimental procedure in those days. Then he excised the ballooned area of Walter’s heart, oversewing the defect with rows of heavy silk. Finally, he replaced both the mitral and aortic valves.
   The instant the repair was complete, Thomas tried to take Walter from the heart-lung machine. By this time, unknown to Thomas, a significant audience had gathered. There was a murmur of sadness when it was obvious that Walter’s heart did not have the strength to pump the blood. Undaunted, Thomas started the counterpulsation device he had positioned before the operation.
   He would always remember his elation when Walter’s heart responded. Not only was Walter taken off the heart-lung machine, but three hours later in the recovery room even the counterpulsation assist was no longer needed. Thomas felt as if he had created life. The excitement was like a fix. For months afterward he was carried away by open-heart surgery. Reaching in, touching the heart, defying death with his own two hands—it was like playing God. Soon he found he became deeply depressed without the excitement of several such operations a week. When he went into practice he scheduled one, two, three such procedures a day. His reputation was so great that there was an endless stream of patients. As long as the hospital allowed him sufficient time in the OR, Thomas was supremely happy. But if another department or the boys in full-time academic medicine attempted to cut back his operating hours, Thomas became as tense and angry as an addict deprived of his daily drug. He needed to operate in order to survive. He needed to feel Godlike in order not to consider himself a failure. He needed the awed approval of other people, the unquestioning approval that was in Larry Owen’s eyes this moment as he asked, “Have you decided if you’re going to do a double or triple bypass?”
   The question brought Thomas back to the present.
   “It’s a good exposure,” said Thomas, appreciating Larry’s work. “We might as well do three provided you got enough saphenous vein.”
   “More than enough,” said Larry with enthusiasm. Prior to opening the chest, Larry had carefully removed a length of vein from Mr. Campbell’s leg.
   “All right,” said Thomas with authority. “Let’s get this show on the road. Is the pump ready?”
   “All ready,” said Phil Baxter, checking his dials and gauges.
   “Forceps and scalpel,” said Thomas.

  Swiftly but without haste, Thomas began to work. Within minutes the patient was on the heart-lung machine. Thomas’s operative technique was deliberate and without wasted motion. His knowledge of the anatomy was encyclopedic, as was his sense of feel for the tissue. He handled sutures with an economy of precise motion that was a joy for the aspiring surgeons to watch. Every stitch was perfectly placed. He’d done so many bypass procedures, he could almost function by rote, but the excitement of working on the heart never failed to stir him.
   When he was through and convinced the bypasses were all sound and there was no excessive bleeding, Thomas stepped back from the table and snapped off his gloves.
   “I trust you’ll be able to put back the chest wall the way you found it, Larry,” said Kingsley, turning to leave. “I’ll be available if there is any trouble.” As he left, he heard an audible sigh of appreciation from the residents.
   Outside the operating room, the corridor was jammed with people. At that time of day, midafternoon, most of the thirty-six operating rooms were still occupied. Patients, either going to or coming from their surgery, were wheeled through on gurneys, sometimes with teams of people in attendance. Thomas moved among the crowd, occasionally hearing his name whispered.
   As he passed the clock outside of central supply, he realized that he’d done Mr. Campbell in less than one hour. In fact, he’d done three bypass cases that day in the time it took most surgeons to do one or two at best.
   Thomas told himself that he could have scheduled another operation although he recognized this was not true. The reason he had scheduled only three cases was the bothersome new rule that all surgeons attend Friday afternoon cardiac surgical conference, a relatively recent creation of the chief of the department, Dr. Norman Ballantine. Thomas went, not because he was ordered to do so, but because it had become the ad hoc admitting committee for the department of cardiac surgery. Thomas tried not to think about the situation, because whenever he did so, it made him furious.
   “Dr. Kingsley,” called a harsh voice, interrupting Thomas’s thoughts.
   Priscilla Grenier, the overbearing director of the OR, was waving a pen at him. Thomas gave her credit for being a hard worker and putting in long hours. It was no picnic keeping the thirty-six operating rooms at the Boston Memorial working smoothly. Yet he could not tolerate it when she insinuated herself in his affairs, something that she seemed eager to do. She always had some order or instruction.
   “Dr. Kingsley,” called Priscilla. “Mr. Campbell’s daughter is in the waiting room, and you should go down and see her before you change.” Without waiting for a reply, Priscilla turned back to her desk.
   With difficulty, Thomas contained his annoyance and continued down the hall without acknowledging the comment. Some of the euphoria he had felt in the OR left him. Lately he found the pleasure in each surgical success increasingly fleeting.
   At first Thomas thought he’d ignore Priscilla, change into his suit, then stop in to see Mr. Campbell’s daughter. However, the fact remained that he felt obligated to remain in his scrub clothes until Mr. Campbell had reached the recovery room, just in case there were unforeseen complications.
   Banging open the door to the surgical lounge with his hand, Thomas stopped at the coat rack and rummaged for a long white coat to put over his scrub clothes. As he pulled it on, he thought about the unnecessary frustrations he was forced to endure. The quality of the nurses had definitely gone down. And Priscilla Grenier! It seemed like only yesterday that people like her knew their place. And compulsory Friday afternoon conferences… God!
   In a distracted state, Thomas walked down to the waiting room. This was a relatively new addition to the hospital, which had been created out of an old storeroom. As the number of bypass procedures done by the department had soared, it was decided that there should be a special room close by where family members could stay until their loved ones were out of the OR. It had been the brainchild of one of the assistant administrators and turned out to be a gold mine for public relations.
   When Thomas entered the room, which was tastefully decorated with pale blue walls and white trim, his attention was caught by an emotional outburst in the corner.
   “Why, why?” shouted a small, distraught woman.
   “There, there,” said Dr. George Sherman, trying to calm the sobbing woman. “I’m sure they did all they could to save Sam. We knew his heart was not normal. It could have happened at any time.”
   “But he’d been happy at the home. We should have let him be. Why did I let you talk me into bringing him here. You told me there was some risk if you operated. You never told me there was a risk during the catheterization. Oh God.”
   The woman’s tears overwhelmed her. She began to sag, and Dr. Sherman reached out to catch her arm.
   Thomas rushed over to George’s side and helped support the woman. He exchanged glances with George, who rolled his eyes at the outburst. As a member of the full-time cardiac staff, Thomas did not have a high regard for Dr. George Sherman, but under the circumstances he felt obligated to lend a hand. Together they sat the bereaved mother down. She buried her face in her hands, her hunched-over shoulders jerking as she continued to sob.
   “Her son arrested down in X ray during a catheterization,” whispered George. “He was badly retarded and had physical problems as well.”
   Before Thomas could respond, a priest and another man, who was apparently the woman’s husband, arrived. They all embraced, which seemed to give the woman renewed strength. Together they hurriedly left the room.
   George straightened up. It was obvious that the situation had unnerved him. Thomas felt like repeating the woman’s question about why the child had been taken from the institution where he’d apparently been happy, but he didn’t have the heart.
   “What a way to make a living,” said George self-consciously as he left the room.
   Thomas scanned the faces of the people remaining. They were looking at him with a mixture of empathy and fear. All of them had family members currently undergoing surgery, and such a scene was extremely disquieting. Thomas looked for Campbell’s daughter. She was sitting by the window, pale and expectant, arms on her knees, hands clasped. Thomas walked over to her and looked down. He’d seen her once before in his office and knew her name was Laura. She was a handsome woman, probably about thirty, with fine light brown hair pulled back from her forehead in a long ponytail.
   “The case went fine,” he said gently.
   In response, Laura leaped to her feet and threw herself at Thomas, pressing herself against him and flinging her arms around his neck. “Thank you,” she said, bursting into tears. “Thank you.”
   Thomas stood stiffly, absorbing the display of emotion. Her outburst had taken him by complete surprise. He realized that other people were watching and tried to disengage himself, but Laura refused to let go. Thomas remembered that after his first open-heart success, Mr. Nazzaro’s family had been equally hysterical in their thanks. At that time Thomas had shared their happiness. The whole family had hugged him and Thomas had hugged them back. He could sense the respect and gratitude they felt toward him. It had been an unbelievably heady experience, and Thomas recalled the event with strong nostalgia. Now he knew his reactions were more complicated. He often did three to five cases a day. More often than not he knew little or nothing about his patients save for their preoperative physiological data. Mr. Campbell was a good example.
   “I wish there was something I could do for you,” whispered Laura, her arms still tightly wrapped around Thomas’s neck. “Anything.”
   Thomas looked down at the curve of her buttocks, accentuated by the silk dress that hugged her form. Disturbingly he could feel her thighs pressed against his own, and he knew he had to get away.
   Reaching up, he detached Laura’s encircling arms.
   “You’ll be able to talk with your father in the morning,” said Thomas.
   She nodded, suddenly embarrassed by her behavior.
   Thomas left her and walked from the waiting room with a feeling of anxiety that he did not understand. He wondered if it was fatigue, although he had not felt tired earlier even though he’d been up a good portion of the previous night on an emergency operation. Returning the white coat to the rack, he tried to shrug off his mood.
   Before going into the lounge, Thomas paid a visit to the recovery room. His two previous cases, Victor Marlborough and Gwendolen Hasbruck, were stable and doing predictably well, but as he looked down at their faces he felt his anxiety increase. He wouldn’t have recognized them in a crowd although he’d held their hearts in his hand just hours before.
   Feeling distracted and irritated by the forced camaraderie of the recovery room, Thomas retreated to the surgical lounge. He didn’t particularly care for the taste of coffee, but he poured himself a cup and took it over to one of the overstuffed leather armchairs in the far corner. The living section of the Boston Globe was on the floor, and he picked it up, more as a defense than for what it contained. Thomas didn’t feel like being trapped into small talk with any of the OR personnel. But the ploy didn’t work.
   “Thanks for the help in the waiting room.”
   Thomas lowered the paper and looked up into the broad face of George Sherman. He had a heavy beard, and by that time in the afternoon it appeared as if he’d forgotten to shave that morning. He was a stocky, athletic-looking man an inch or two shorter than Thomas’s six feet, but his thick, curly hair made him look the same height. He had already changed back to his street clothes, which included a wrinkled blue button-down shirt that appeared as if it had never felt the flat surface of an iron, a striped tie, and a corduroy jacket somewhat threadbare on the elbows.
   George Sherman was one of the few unmarried surgeons. What put him in a unique class was that at age forty he’d never been married. The other bachelors were either separated or divorced. And George was a particular favorite among the younger nurses. They loved to tease him about his errant bachelor’s life, offering help in various ways. George’s intelligence and humor took all this in stride, and he milked it for all it was worth. Thomas found it all exceedingly irritating.
   “The poor woman was pretty upset,” said Thomas. Once again he had to refrain from making some comment concerning the advisability of bringing such a case into the hospital. Instead he raised his paper.
   “It was an unexpected complication,” said George, undeterred. “I understand that good-looking chick in the waiting room was your patient’s daughter.”
   Thomas slowly lowered his paper again.
   “I didn’t notice she was particularly attractive,” Thomas said shortly.
   “Then how about sharing her name and phone number?” said George with a chuckle. When Thomas failed to respond, George tactfully changed the subject. “Did you hear that one of Ballantine’s patients arrested and died during the night?”
   “I was aware of it,” said Thomas.
   “The guy was an admitted homosexual,” said George.
   “That I didn’t know,” said Thomas with disinterest. “I also didn’t know that the presence or absence of homosexuality was part of a routine cardiac surgical work-up.”
   “It should be,” said George.
   “And why do you think so?” asked Thomas.
   “You’ll find out,” said George, raising an eyebrow. “Tomorrow in Grand Rounds.”
   “I can’t wait,” said Thomas.
   “See you in conference this afternoon, sport,” said George, giving Thomas a playful thump on the shoulder.
   Thomas watched the man saunter away from him. It annoyed him to be touched and pummeled like that. It seemed so juvenile. While he watched, George joined a group of residents and scrub nurses slumped over several chairs near the window. Laughter and raised voices drifted across the room. The truth was that Thomas could not stand George Sherman. He was convinced George was a man bent on accumulating the trappings of success to cover a basic mediocrity in surgical skill. It was all too familiar to Thomas. One of the seemingly inadvertent evils of the academic medical center was that appointments were more political than anything else. And George was political. He was quick-witted, a good conversationalist, and socialized easily. Most important, he thrived within the bureaucratic committee system of hospital politics. He’d learned early that for success it was more important to study Machiavelli than Halstead.
   Thomas knew that the root of the problem was an antagonism between the doctors on the teaching staff like himself, who had private practices and earned their incomes by billing their patients, and the doctors like George Sherman, who were full-time employees of the medical school and received salaries instead of fees for service. The private doctors had substantially higher incomes and more freedom. They did not have to submit to a higher authority. The full-time doctors had more impressive titles and easier schedules, but there was always someone over them to tell them what to do.
   The hospital was caught in the middle. It liked the high census and money brought in by the private doctors, and, at the same time, it enjoyed the credibility and status of being part of the university medical school.
   “Campbell’s chest is closed,” said Larry, interrupting Thomas’s thoughts. “The residents are closing the skin. All signs are stable and normal.”
   Tossing the newspaper aside, Thomas got up from the chair and followed Larry toward the dressing room. As he passed behind George, Thomas could hear him talking about forming some kind of new teaching committee. It never stopped! Nor did the pressure that George, as head of the teaching service, and Ballantine, as head of the department, applied to Thomas, trying to convince him to give up his practice and join the full-time staff. They tried to entice him by offering him a full professorship, and although there’d been a time when that might have interested Thomas, now it held no appeal whatsoever. He’d keep his practice, his autonomy, his income, and his sanity. Thomas knew if he went fulltime it would only be a matter of time before he was told who he could and who he could not operate on. Before long he’d be assigned ridiculous cases like the poor mentally retarded kid in the cath room.
   Tense and angry, Thomas went into the dressing area and opened his locker. As he pulled off his scrub clothes and tossed them into the hamper, he recalled Laura Campbell’s pliant body pressed against his own. It was a welcome and pleasant image and had the effect of mollifying his frazzled nerves. Ever since he’d left the OR, his pleasure in operating had dissipated, leaving him increasingly tense.
   “As usual, you did a superb job today,” said Larry, noting Thomas’s grim face and hoping to please him.
   Thomas didn’t respond. In the past he would have loved such a compliment, but now it didn’t seem to make any difference.
   “It’s too bad that people can’t appreciate the details,” said Larry, buttoning his shirt. “They’d have a totally different idea of surgery if they did. They’d also be more careful who they let operate on them.”