Flashback

CHAPTER ELEVEN

The 1938 fleet monoplane cut through the warm midday air like an arrow, soared over the dense forest panoply and then across the broad, grassy field. It dipped and looped like a yo-yo, barrel rolling again and again, sunlight exploding off the hand polished, crimson butyrate paint of its wings. At the far edge of the meadow it nosed upward, streaking toward a solitary puff of cloud in an otherwise flawless sky. From his spot on a large boulder, Zachary watched intently as his fingers, through minute movements of the stick atop his radio control, choreographed the flight. A stall, a spin, a roll out, a second pass over the field, Zack had built the Fleet as a high schooler, and although he had sometimes gone a year or more without the opportunity to fly her, he had kept the engine and the finish in perfect condition.

With a final, wide bank, he eased the model upwind and set her down sweetly in the grass. The plane was, as always, fascinating to watch, and this day, with any luck, she would be more than just a hobby. This day, she would be a toot to help him unlock the tortured silence of a young boy. "Hey, Ace, that was a nifty piece of flying."

Suzanne, dressed in snug white shorts and a Dartmouth T-shirt, stood on a small rise, looking as if she might have just drifted down from the sun. She had a plaid blanket draped over one arm and a wicker picnic basket hanging from the other. "You know, " he said, squinting up at her, "about twenty minutes ago I started getting this funny feeling you might show up."

"Do we have time for lunch?

" she asked, making her way down the slope. Zack glanced at his watch.

"About forty-five minutes. I'm glad you're here." Suzanne stretched on her tiptoes and kissed him lightly on the mouth. "Me, too," she said.

"Can I set this food out, or is Cheap dog lurking somewhere? "

"No, no. Mop-face and the Fleet out there are avowed enemies. Sort of like sibling rivalry. He's home digging up the yard."

She spread the blanket and set out dishes of fried chicken, smoked fish, and salad. Then she extracted a small portable radio, set it on the grass, and fiddled with the dial until she found WEVO. The announcer was thanking his guests for participating in Midday Roundtable and inviting listeners to stay turned for a special edition of Music of the Masters.

"You must think I'm a little crazy for the way I've been acting around you, " she said as she poured lemonade. "I wanted to apologize. Zack shrugged. "No need, " he said. "You've had a few more important things to deal with than me."

"Perhaps. Just the same, I've been acting like a jerk, and I'm sorry."

He reached over and brushed her cheek with the back of his hand. "Fair enough, " he said. "If that's what you need, then apology accepted. There, do you feel better?"

"Zack, I… I want to explain."

"Hey, I don't require any-"

"No, I want to." She studied her hands. "At least I think I do."

For much of the night she had sat with Helene, struggling to come to grips with the past. "Nothing matters except the truth, " her friend had said. "Nothing matters except how you really, truly feel. Right here, in your gut. I go out the way I do, see men the way I do, because I honestly know, in my heart, that I hate being alone. Otherwise I'd stay at home or join the Ammonoosuc Valley Quilters. Believe me I would. You don't have to do it my way, or anyone else's way for that matter, but your own, Suze. But-and it's a big but-you can't keep fighting your feelings. You can't fight who you are. If you think you care about the man, tell him who you are, where you've been. If he can deal with it, fine. If he can't, that's his problem."

It all had made so much sense while they were talking. Now, Suzanne was not so sure. There was more than a little to be said for living the safe life. The meadow, abutting the low hills southwest of town, glowed verdant and golden in the dry afternoon sun. For a time they ate in silence, save for the deep, cultured voice of the WEVO announcer, who was extolling the virtues of an English composer whose name Zack missed.

"Zachary, " Suzanne said suddenly, "the other night was the first time I've made love in more than three years."

"Well, you certainly haven't gotten rusty, " he replied. "I would also guess that whatever the reason for those three years of celibacy, it wasn't a lack of offers."

She smiled at him wistfully. "You're sweet. Actually, there haven't been that many. I haven't been able to trust any man enough even to be encouraging." 17 "If you're trying to make me feel special, you're doing a great job. "You are special… Zack, my husband-my ex-husband-did an incredible hatchet job on my life, and then left me for dead. The scars that formed just don't seem to want to heal. I don't put all the blame on him for what happened. I could have put my foot down when I figured out what was going on. I could have gotten out. But I stayed. I always told myself it was for Jen, but looking back, I realize that I simply couldn't admit to myself how blind I had been-how badly I had misjudged the man I had married. And I couldn't accept that he didn't care enough about me to change."

"You were young."

"Twenty-three, if you call that young. And not a very worldly twenty-three at that. Paul was a Ph. D. Brilliant, handsome, charming as hell. Already an associate professor at thirty-five. Every woman in school had a crush on him. Unfortunately, what they didn't know what I didn't know-was how sick he was inside. He was a sociopath, Zachary. A womanizer, a drug addict, and a glib, an unbelievably glib liar. He used me. In every way imaginable, he used me."

She searched Zack's eyes for any signs of judgment or revulsion, but saw only sadness. "You don't have to share any more of this if you don't want to, " he said, taking her hand. "No, I'm okay. Much better than I thought I'd be. You're really very easy to talk to. "For several years,

" she went on, "Paul stole prescriptions from the hospital, made them out to his women or his cronies or to people who didn't even exist, and signed my name. He had my signature down even better than I did. He hit up a dozen or more wholesale houses and worked his way through just about every pharmacy in the state."

"Jesus…"

Suzanne gazed off toward the mountains to the south and began rubbing at her eyes. "Are you okay? " Zack asked. "Huh?… Oh, sure. I'm fine. Fine."

She fished through her purse and put on her sunglasses. "Where was IT?"

"You were telling me about the prescriptions. Listen, if you want to change the subject, it's perfectly-"

"No, no. It feels good to be able to talk about it." She reached beneath her sunglasses and again rubbed her eyes. "Besides, there's not that much more to tell. Somehow Paul must have found out that the DEA people were on to me, because a week before they showed up at our door, he emptied out our bank account, sold everything we had of value, and took off. No note, no call, nothing. Jen was only two at the time. A year or so later, I heard that he was teaching at a medical school in Mexico.

Somebody else said they s'nv him at an international conference in Milan. But by that time all I wanted was never to hear his name again."

"What happened to you?"

"Pardon?"

"I asked what happened to you. Suze, are you sure you're all right?"

"Is the glare bothering you?"

"No. Why?"

"Nothing… nothing. What did you ask?"

"Suzanne, let's just leave it for another time-"

"No! Now, wh-what was it?"

She continued to stare off at the mountains. The muscles in her face had grown lax and expressionless. Her hands had begun to tremble. Zack studied her uncomfortably. He glanced at his watch. Barbara Nelms and her son were due in ten minutes. "Suzanne?"

She did not respond. "Listen, " he said, shutting off the radio and putting it back into the wicker basket. "I think maybe you've shared enough for one day." He began repacking the leftovers. "I'm just happy you felt able to talk about it with-"

"You know, ridiculous as it may sound, " Suzanne went on fluidly, "I'm not sure I know exactly what happened next…"

Zack looked at her queerly. The lifelessness was gone from her face and her voice, and she was as animated as ever. He battled back the urge to again ask her if she was okay.".. One minute, I was suspended from the hospital, sitting in lawyers' offices, fighting with the child welfare people and trying to fend off the DEA animals, and the next I was here in Sterling, putting in pacemakers."

Zack studied her for any lingering sign of distraction, but saw none. It was as if a cloud bad passed briefly across the sun and then had suddenly released it. He forced concern from his mind. She seemed, as she had claimed, to be absolutely fine. "Did Frank have a hand in that?

" he managed. "I guess. One day he called, the next day he came down and interviewed me, and the next day, it seemed, the pressure that had been on me from all those sides began to disappear."

"Well, good for Frank." Zack felt his tension recede. "We haven't been getting along too well lately. I think I'll have to try a little harder. "

"I'm not really sure if it was him or Ultramed, " she said, "but someone got the wolves off my back."

"That's a horrible story."

"Except for the ending, it is."

"Call that part of it the beginning, " Zack said. "I hope telling you all of that helps you see why I've had a little problem with letting a man back into my life. And also why I feel obligated to support Ultramed wherever I can. Thanks to Paul, loyalty has moved ahead of just about everything else on my list of qualities that matter in a person."

"I understand."

She kissed him-once, and then again. The last drop of his worry vanished. "So, " she said, still cradling his face in her hands, "just be patient with me, okay?"

"Just once in more than three years, huh?"

He repacked the last of their lunch and pulled her down to him. "As soon as we have a little time, I'd like to help you improve on that average."

She brushed her lips across his neck. "In that case, just don't stop trying. My horoscope told me to be on the lookout for a tall, dark stranger who did coin tricks."

He ran his fingers slowly down the back of her thigh and over her calf., Thanks for the picnic, " he said. "Thanks for dessert. And listen, good luck with the Nelms boy, I hope this works out. If you get anywhere today, I think we should consider writing up our technique for some journal. We can title the article Pediatric Neurology Alfresco."

She pushed herself to her feet. Zack walked her to her car and watched until she had disappeared down the hill. Then he returned to the field, absently humming a passage from Fantasia on Greensteeves by Ralph Vaughan Williams. Toby Nelms looked chronically ill. His skin was midwinter pale, with several small patches of impetigo alongside his nose and at the corner of his lips. He was thin as a war orphan and carried himself with a dispirited posture, his gaze nearly fixed on the ground. But it was the listless, dull gray of his eyes that worried Zack the most. They were the eyes of utter defeat which he had encountered so many times in terminally ill patients-the eyes of death. At Zack's request, Barbara Nelms hugged her son, promised to return for him as soon as she had finished shopping, and drove back down the hill to town.

If Toby was frightened at her departure, his dispassionate expression hid the fact well. He had spotted the Fleet almost immediately, and had glanced over at it twice before she had even started to drive off. Zack reflected on Brookings's account of the child's terrified dash across the clinic parking lot, and knew that, for the moment at least, he was making progress. A tumor, a seizure disorder, a congenital, slowly developing vascular abnormality, a toxic reaction to something the boy was consuming without anyone's knowledge-Zack had balanced the possibilities against the psychiatric diagnoses and found all of them wanting. He had even made a brief drive around the boy's neighborhood, searching for a landfill or other dumping site where Toby might be sustaining a chemical exposure. Nothing. "Hi, kiddo, " Zack said, kneeling on the grass, two yards away from the boy. "My name is Zack."

There was curiosity in the boy's eyes, but no other reaction. "I'm a doctor, but I'm not going to examine you, or do any tests, or even touch you. Please believe that. I would like you to learn to trust that I would never lie to you, and that I mean exactly what I say, okay?

I'll say it once more. I will never, ever lie to you. I asked your mom to bring you here because I thought it might be easier for us to get to know one another outside the hospital."

At the mention of the word hospital, a shadow of fear darkened the boy's expression. "Your mom will be back as soon as she finishes her shopping,

" Zack added quickly. "Meanwhile, we can lie around, or explore, or even climb up to that little cliff over there. This place is called the Meadows. I used to play here when I was a boy." He flashed momentarily on Suzanne. "I still do, in fact, " he added. Toby's eyes darted again toward the Fleet. "I built that plane over there a long time ago, " Zack explained. "It flies by remote control." He held up the control box for the boy to see. "She loops, and rolls over, and zooms up to the clouds.

Go ahead. Take look at her."

Toby Nelms remained where he was, but there could be no mistaking his interest. "Go on. It's okay. I'm going back to the car for a second to get Some fuel for her.", Only when he had reached the van did Zack turn back. The boy was kneeling by the Fleet, and was, ever so gently, running his fingers over the shiny, lacquered finish of her wings. Too anxious to stay away for the last fifteen minutes of the agreed-upon hour, Barbara Nelms rolled to stop some distance downhill from the meadow and made her way quietly toward Zack's van, half expecting to find her son waiting there, in near hysterics, for her return. What she found instead, was a note, taped to the rear window. Mrs. Nelmstake a peek if you want, but please, try not to be seen. No words from Toby yet, but we're getting there. I need another hour. Please call my office and ask my receptionist to do the best she can with my schedule. See you later. Z. Iverson From just beyond a small rise, she could hear the high-pitched whine of the model-airplane engine. Crouching low, she worked her way up. Near the crest of the hillock, she flattened herself in the tall grass and then peered over. Zachary Iverson sat alone, his back toward her. Her son was nowhere in sight. Suddenly terrified at what she might have done by trusting a man who was little more to her than a voice on the phone, she began to scramble to her feet. Then, just as quickly, she dropped back down. The boy was there, nestled between the physician's legs, sharing the stick of the radio-control device.

"That's it, fella, " she heard Zack cry over the noise. "A little more, a little more, and… now!"

The plane, which had begun a slow roll across the grass, shot forward and then up, climbing at a steep angle toward the treetops at the far end of the meadow. "That's it. You've got it. Now ease off. Ease off.

Terrific! Hold her right there."

Now well above the trees, the model banked smoothly to the south and began a lazy circle of the field. "I did it! I did it!"

It took several seconds for Barbara Nelms to realize that the excited voice she had just heard was her son's. With a joyful fullness in her throat and tears in her eyes, she slipped back out of sight and hurried down the hill. Zack and Toby Nelms lay opposite one another on the warm grass, a few yards from the Fleet, chewing on stalks of wild barley and watching a red-tailed hawk glide in effortless loops atop high, midday thermals. "Now, just who do you suppose is working the radio-control box for that model? " Zack asked. "Whoever it is has sure built one quiet engincl "That's goofy, " Toby Nelms said. "Of course it is. Any one with half a brain could tell that's just a kite. Now, if only I could see the string…"

Once the logjam of silence-of fear and mistrust-had been broken, the boy's words had come with surprising ease, and even occasional spontaneity. Zack had been reluctant to test the progress they had made with any pointed questions, but now, with just a few minutes left in their two hours together, he felt comfortable enough to try. "You know, kiddo, " he began, "a lot of people have been very worried about you these past few months."

"I know."

"But you still won't talk to anyone?"

Toby shook his head. "Not even your parents? " The boy stared vacantly at the crucifix soaring overhead. "They never help me," he said suddenly. "I scream for them, and beg them to stop the… the man from hurting me. But they never come until it's too late. They never stop him."

"What man? " Zack asked, at once repulsed and fearful at the thought of the boy being molested. "Who's been hurting you?"

Toby turned away. "Hey, kiddo, I'm sorry. I didn't mean to say anything to upset you or frighten you."

For a few, anxious seconds, Zack feared he had pushed too hard and slammed the door he had, so gingerly, just opened., The man with the mask, " Toby said without turning back. "Mask?"

The boy shifted restlessly, and then drew his knees and elbows in tightly to his body. Zack decided he had gone far enough for one day. He reached in his pocket for a coin. One good thumb palm and they would call it quits. "He… he cuts it off, " Toby said, in almost a whimper.

"And… and then it grows back… and then he cuts it off again."

"Cuts what off, Toby?… Look, I know it's hard for you to talk about, but you've got to try."

He moved to put his hand on the boy's shoulder, but then thought better of it. He felt his heart pounding. Don't stop now, kiddo.

Don't give Up on me now. "My… my peenie. And my balls, too."

"Do you mean he touches you?"

"No, he cuts it off. He promises he won't hurt me. He promises he'll fix my lump, and then he cuts it off. And it hurts. It hurts and I scream at him, and he won't stop. And I scream for my mommy and daddy, and they never come."

The boy began to cry, his shoulders jerking spasmodically with each heavy sob. Again, Zack moved to touch him, but before he could, the child spun and flung his arms around him. "Please, Zack, " he cried softly. "Please don't let him do it anymore."

He promises he'll fix my lump… Suddenly, the child's words registered. "Toby, " Zack whispered, still holding the boy tightly, "the lump you're talking about, is it your hernia? That place here you had fixed?"

The boy nodded, his body still racked with sobs. "And the man with the mask… Is that the doctor? " Again, a nod. Zack eased him away, but continued to hold him by the shoulders. "Toby, look at me. I think you've just been having nightmares. Bad, horrible dreams, but dreams that often go away as soon as you see them for what they are. The operation was perfect. All that's left is a little scar. The lump is gone for good."

"No, " the boy said angrily. "It isn't. It grows back. So does my peenie, and my balls. But then he cuts them off again, and it hurts worse each time."

Inwardly, Zack sighed relief. The boy's profound disturbance was rooted in a nightmare-the expression of pent-up fears surrounding a procedure now nearly a year in the past. Fascinating, but certainly neither difficult to understand nor as bad a situation as he had feared. At least Brookings would have something to work with. "You don't believe me, do you? " Toby said. "It's not a dream. He cuts them off, and they grow back, and then he takes those Metzenbaums and cuts them off again."

Zack felt a sudden, vicious chill. "He takes what? " There was no hiding the incredulity in his voice. "The Metzenbaums. He asks for them from the nurse, and then he sticks them into me right here, and it kills me.

Then he just cuts and cuts."

"Toby, think," Zack said urgently. "Have you ever heard anyone else say that word?"

"What word?"

"Metzenbaums, Toby. Have you ever heard anyone except the doctor in your nightmare say that word?"

Toby Nelms shook his head. Zack released the boy and sank back on his hands. Something was wrong. Something was terribly wrong. Metzenbaum scissors were commonly used in surgery, but rarely, if ever, until after the initial skin incision had been made. Toby Nelms would have been asleep at the time they were called for. Anesthetized. There was no way he could have heard that term, let alone so accurately understood what it meant. No way. But somehow, he had. By THE TIME Zack had finished rounds and headed from the hospital to his office, evening had settled in over the valley. To the southwest, the silhouetted mountains were ebony cutouts against the deepening indigo sky. It was a quiet, awesome evening, perfect for a run by Schroon Lake or for a horseback ride into the foothills to watch the moonrise. It was an evening to celebrate the joy of living. But for Zack, the magic of the evening was lost in reflection on the agonized struggles of an old surgeon and the desperate plea of the nurse who had condemned him, and in concern as to how much to tell the waiting parents of a child who was sinking deeper and deeper into a hell of dreams that were not dreams-dreams that cut and hurt and maimed. As he crossed the parking lot, Zack noticed Frank's Porsche, tucked in its reserved slot. Early mornings, late evenings, weekends-for whatever his shortcomings and the failings of his past, the man had become a demon of a worker. Soon, Zack knew, the two of them would have to talk. There were things Frank needed to learn of and to understand about Ultramed, about Guy Beaulieu… and now, especially, about Toby Nelms. The boy's condition was clearly on a downward spiral, and each passing day was a lost ally in the struggle to uncover the truth. With Frank's help, the odds of finding answers in time to make a difference Would be considerably shorter. But would he listen? Over the years, the two of them had drifted far apart in many ways. The disagreement over Guy Beaulieu had only underscored their differences. Still, Zack reasoned, they were brothers, and they each had a significant stake in Ultramed-Davis and in Sterling. He glanced back at the Porsche. At seven that morning, when he had arrived for work, it was already there. Now, after more than thirteen hours, Frank was still at it. What more testimony did he need? The man had hitched his wagon to the Ultramed-Davis star. If there was a threat to the integrity of the hospital, he would listen. Zack felt sure, at least, of that much. But he also knew that all he had were theories-gut sensations plus a few million questions. His brother was a company man. If there were trouble in his paradise, it would take more than suspicions to enlist his help-much more. Barbara Nelms and her husband were waiting on one of the stone benches that flanked the entrance to the Physicians and Surgeons Clinic. Bob Nelms, clean-cut, fit, and hardy, had clearly borne less of the day-to-day strain of Toby's illness than had his wife. He greeted Zack with a firm hand. "Pleasure to meet you, " he said. "Barbara tells me you made some real progress with our boy. That's excellent.

Excellent. Using that plane of yours was just a super idea."

"Thank you, but-"

"You know, I'm no professional, but I've been trying to tell Barbara all along that this was all just a nasty phase, and that when that kid of ours was doggone good and ready he would get through it. It sounds like you two made quite a large step in that direction today."

"Call it a baby step, " Zack said. Despite the machismo in Bob Nelms's words and manner, one look in his eyes and Zack knew the man was whistling in the dark. As a supervisor at the mill, he was used to accepting the burden of difficult problems and solving them. His thin-shelled denial would require delicate handling and constant awareness that Toby's condition was no less baffling and frightening to Bob Nelms than his impotence in the face of it. As Zack followed the couple into the elevator, he wondered once again how much to share with them. It had never been his way to withhold information from his patients or, when the patient was comatose or a juvenile, from their families. But this was not information. It was the purest conjecture.

And even when he tested the explanation on himself, it sounded nothing short of phantasmagoric. Mr. and Mrs. Nelms, I don't know how to tell you this, but I believe that your son was not asleep during his hernia operation last year. He appeared to his surgeon and anesthesiologist to be fully anesthetized But somehow, at some level, he not only "saw" his operation from within his body, but, it would seem, he jitlly experienced the pain of it as well Now, in some perverted, distorted way, he is reliving that surgery in terrifying flashbacks, much like those described in LSD users… No. I don't have any idea how that could happen… No, to the best o my knowledge, such a phenomenon has never been reported with the anesthetics he received… No, I don't have any hard evidence to back up what I say… No, I don't know what could possibly be causing the attacks… No, I don't have any idea…

I don't know… I don't know… I don't know…"

His suspicions were vague, fantastic, and virtually without proof.

Disclosure of them to the boy's parents would almost certainly precipitate premature action by them against Ultramed, the hospital, and the physicians involved in Toby's surgery-action Zack was in no position yet to support, and which could well lead to a coverup of the truth… whatever that was, "Mr. and Mrs. Nelms," he began once the couple was settled in across the desk from him. "I'm afraid I don't have very much to tell you at this point. Toby did not share a great deal with me.

However, he did say enough for me to suspect that he is having very severe fright reactions, and that while these reactions are occurring he is completely unable to distinguish them from reality. In other words, in just a few seconds, apparently with very little warning, he is transported from wherever he happens to be into another reality-a very distorted, very terrifying reality."

"Are you saying he becomes insane? " Barbara Nelms asked. "You've observed him, " Zack responded, still feeling his way along. "What do you think?"

"But… but insanity is a condition, isn't it? A state of being.

How can it possibly flick on and off like a light?"

"And what has the hospital got to do with it? " Bob Nelms added. "I don't know," Zack said, wondering how many more times he would hear himself repeat that phrase. "Well, what do you think?"

Zack tapped his fingers together, stalling for a few more seconds to sort his thoughts. As much as he hated deception, this simply was not the time to air his theory. "I assume you are both somewhat familiar with epilepsy? " he began. "Well, most people think of epilepsy as an electrical disorder of the brain which causes periodic fits. The seizures we are most familiar with are motor seizures-that is, they involve the muscles and the extremities. But supposing the electrical explosion occurs in one or more Of the cognitive areas of the brain-the thinking areas. What would result would still be a seizure, but it would be a sensory seizure rather than a motor one."

"Are you trying to tell us that Toby has petit mal or temporal-lobe CPILEPSY? " Barbara asked. "I've read everything I could get my hands on about both conditions, and quite frankly, Dr. Iverson, I don't think Toby's condition fits either one. He is aggressive like temporal-lobe epileptics, but only because he is absolutely terrified. And very little of his behavior resembles the detached, fugue reactions that I've read about in petit mal. And although the resting electroencephalogram is not that accurate in making either diagnosis, Toby's was normal the one time he had it done."

Zack felt his cheeks flush and cautioned himself against any elaborate untruths, Barbara Nelms was too desperate and too bright. She was tired of getting the runaround from medical and mental health professionals, and she had done her homework well. "I don't know what to say, Mrs.

Nelms, " he countered, "except to point out that if Toby's case were straightforward and typical, someone would have diagnosed it before now."

"What about the hospital? " Bob Nelms asked again. "Didn't the boy say anything to you to explain why he seems so frightened?"

"Nothing specific, " Zack lied. "But since that's the main clue we have, I do feel that's the direction our investigation should go."

Barbara Nelms slumped visibly. "Dr. Iverson, investigations are fine, but you saw Toby. He's like a stick. His skin is getting infected. He gets bruises from almost nothing. He gets fevers with no evidence of infections. He's dying, Dr. Iverson. I swear, time is running out. Our son is dying."

"Barbara, don't say that!"

Bob Nelms blurted. His outburst hit a raw nerve. "Don't tell me what to say and what not to say, " she snapped back. "You're in that damn mill until seven every night. You don't see him."

"Doggone it, Barbara, I'm doing everything I can. You're the one who hasn't paid a bit of attention to anything but Toby these past-"

"Please, " Zack said. "Please. I know this is hard on you both. But sniping at each other isn't helping anyone-least of all Toby."

The couple stopped abruptly and exchanged sheepish looks. "We're sorry,

" Barbara said. She reached over and squeezed her husband's hand. "We never used to fight, even at home alone. But this has just got us all..

" She looked away. "I understand, Mrs. Nelms. All I can ask is that you both just do your best to keep it together, and give me a little time to do some reading and talk to some people. I'll work as rapidly as I can.

I promise you that. And I'll plan on seeing Toby again next week. Same time. Same field."

"Meanwhile?"

Zack shrugged. "Meanwhile, I don't think any specific treatment is indicated. Especially since I don't really know yet what's going on. I will tell you that I don't take my responsibility for my patients lightly, and I'm fully aware that we don't have all the time in the world. I'll do my very best to get to the bottom of things quickly."

He stood, hoping to bring the exchange to a merciful end before Barbara Nelms could hone in on the inadequacies in his explanation.

"Thank you, " Bob said, standing as Zack did and shaking his hand.

Zack walked them to the outer door of his office and again promised to work as quickly as possible. "Dr. Iverson, could you just tell me one thing? " Barbara Nelms asked. "Of course."

"Are you holding anything at all back from us?"

Zack had to force himself to maintain contact with the woman's eyes. It was a technique at which, unlike Frank, he had never excelled. "No, Mrs.

Nelms, " he said flatly. "No, I'm not."

The woman hesitated, and for a moment seemed poised to challenge the denial. Then she reached out and shook his hand. "That being the case, then, thank you, Doctor. You will keep us posted, yes. She took her husband's arm and walked away with him, down the darkened corridor. Zack watched until the elevator doors had closed behind them. He ached from his lies and from the graphic reminder of the power of illness over the lives of whole families. He also knew, from her parting look, that Barbara Nelms would never again allow him to hide behind evasions and half-truths. He would review Toby Nelms's record again, and then contact the National Institutes of Health library in Bethesda for a complete search of the reported adverse reactions to the anesthe ics he had received. Finally, he would meet with Jack Pearl and Jason Mainwaring.

Beyond those steps, there was nowhere to go-nowhere except another session with Toby himself and then the sharing of his suspicions with Frank. Something had happened to the boy during his hospitalization at Ultramed-Davis-something devastating. If nothing else panned out, Frank would have to realize that it was in everyone's best interests that he pursue the matter. He would cooperate, or face Barbara Nelms and her attorney. "Frank, don't move, honey, please. You feel so good. I want to do a little while you're still inside me. Just a line. Okay? " I Frank's secretary, the blond one, was named Annette Dolan. She had moved with her child to live with her mother in Sterling, and had been working as a hostess in the Mountain Laurel Restaurant when Frank first spotted her and offered her a job. Her qualification for the position was, quite plainly, that she looked better in a sweater than any woman he had ever seen. She was a mediocre receptionist, and a far-worse-than-that secretary, but she was sweet and polite to everyone, and had proved a wonderful, undemanding diversion, especially on those occasions when he was able to indulge her passion for cocaine. "Go ahead, baby, " he said, running his thumbs over her nipples. "But hustle. I don't have much time left."

For more than an hour, first on the oriental rug in his office, and then on the couch, Annette had screwed him as only she could-purely and passionately, without any of the head games he tolerated but hated in brighter women. He cradled her breasts in his hands as she slipped one end of a straw into her nose and lowered the other onto the mirror that she had rested on his chest. "That's it, " he whispered as she inhaled the dust. "Get it all, baby. Get it all."

He glanced across at the Lucite clock on his bookshelf. Twenty after eight. Less than an hour until Mainwaring was due. Less than an hour until the beginning of the end. Annette had been the perfect appetizer for that session. Now, however, it was time to pack her up and ship her home. Frank waited until she had wiped the last grains of powder off the mirror and onto her gums. Then he skimmed the mirror across the room and pulled her magnificent, glistening body close to his. Slowly, he toppled off the couch and on top of her on the rug. She was beautiful to the eye and to the touch, but after an hour and a hundred dollars worth of cocaine, she held little excitement for him. All that remained was the mechanical need to climax. He grabbed her corn-silk hair tightly in his fists, buried his chest against her breasts, and rammed himself into her again and again until, in less than a minute, it was over. If only Lisette knew how much he needed this sort of uncomplicated, unquestioning sex, everything would be much better for them, he thought.

Much better. He took a minute to stroke the woman's clit, her tight, flat stomach, and finally her perfect ass. Then he moved to the chair behind his desk and watched as she dressed. Once every week or two was perfect-just enough to keep the adventure fresh and the woman from becoming tiresome. Absently, he thumbed through the papers on his desk-papers that included the application of the surgeon who would be Mainwaring's replacement. The whole business had gone down like clockwork, Frank mused, just as he had promised it would. He and Mainwaring had estimated two years, and precisely two years it had been.

Now, there was less than an hour until the final phase of their project would start. Less than an hour until the beginning of the end, until the beginning of everything good for him. Frank wrapped up what was left of the cocaine and flipped the plastic bag across to the woman. "Here you go, baby, " he said. "Enjoy."

"You promised you would try some with me sometime, Frank. Remember?"

"Sometime, maybe. For now, you just get on home and enjoy it, " he answered. "I don't have much use for that shit. There are enough other things I get off on. Like you."

And, he was thinking, like a million dollars. Frank showered in the bathroom off his office, dressed, and cleaned up the last vestiges of his session with Annette Dolan. Then he settled in before the computer terminal on his desk. There were still twenty minutes before Mainwaring was due-just enough time to check in with Mother. And, Frank noted, it was especially fitting that he should. For at a time when his back was to the wall, when the absence of $250, 000 he had borrowed from the hospital accounts and then lost in that foolish land deal stared at him every day like a gaping, black hole of doom, Mother had provided him with the answer. Mother was Ultr'ma, the Ultramed mainframe computer housed in the home office in Boston. She was the fiber that held the expanding Ultramed empire together, providing it with consistency, rapid exchange of information, and a seemingly endless pool of physicians. And in Frank's darkest, most desperate hour, Mother had served up both Jack Pearl and Jason Mainwaring. Frank activated the terminal, dialed the network number, and flipped the toggle switch on his phone. In seconds, Good evening, welcome to Ultr'maplease enter access code appeared on the screen. Frank typed in the code and then, when requested, his own password. In a week or so his regional director would receive a printout of Ultr'nla users and would note on the appropriate evaluation form that at nine o'clock in the evening of that day, Frank had been hard at work in his office. Good evening, Mr. Iverson. We trust all is well in Sterling, New Hampshire. Do you wish to see your menu?

Frank typed Y. Immediately, ADMINISTRATOR'S MENU flashed on, followed by a list, 1. Changes in procedures and policies manual 2. Ultramed current staff physicians and salaries (your hospital only) 3. Ultramed current staff physicians and salaries (your region only) 4. Available physicians (by specialty) 5. Promotions, reassignments, terminations (past 30 days) 6. National health news of note 7. Regional health news of note 8.

Preferred suppliers and services (your region only) 9. Performance ratings (region) 10. Performance ratings (nation) 11. Golden Circle Administrators As he invariably did when communicating with Mother, Frank began by affirming his membership in the Golden Circle and his position as the leading administrator in the northest region. Leading administrator. Golden Circle. It was laughable now to think of how close he had come to not even applying for the Ultramed-Davis job. But with his electronics firm going down the tubes, the Judge refusing to help him out, and Leigh Baron insisting that he would get serious consideration in the search process despite his lack of hospital experience, he really had nothing to lose. It had been a mild shock when he was finally offered the position. And although there could be no arguing his remarkable success with the corporation, it remained something of a mystery to him why Leigh had picked him over many more experienced candidates. Frank scanned the regional and national rankings and then returned to the Administrator's Menu and summoned up item four.

The physicians of possible interest to the Ultramed system were listed by specialty and subspecialty, along with a detailed but straightforward summary of their education and work experience. However, item four was hardly a typical employment bulletin board.

Included with many of the names was a paragraph summarizing the professional and/or personal difficulties that had made that physician available. Drugs, alcohol, sexual entanglements, financial improprieties, professional misconduct of one sort or anther-compiling the roster was the full-time job of an obsessively diligent investigator in the home office. Primary among her responsibilities was the weeding out of those physicians for whom there was little or no hope of rehabilitation. Those remaining on the list, many of them excellent practitioners, were of particular interest to the corporation. More often than not, they proved to be devoted employees, grateful for a second chance, totally loyal to the company and its policies, and willing to work for any salary that was reasonable. Steve Baumgarten in the emergency ward had been recruited through Ultr'ma's unique bulletin board. So had Suzanne Cole, a real prize, who almost from the start had generated an income many times greater than her salary. But for Frank, it was the one-two parlay of Jack Pearl and Jason Mainwaring that had made Mother worth her megabytes in gold. For a time when Frank's back was to the wall, when he was becoming so desperate about the $250, 000 that he was actually considering approaching the Judge for help, Jack Pearl's name appeared in item four. The description of Pearl's problem, which Frank eventually had memorized, read, Holds patent on what he has claimed is revolutionary new general anesthe ic. Texas license suspended pending investigation of alleged illegal clinical testing of the substance and falsification of information on experimental drug application. Physician with same name resigned 1984 from Wilkes Community Hospital, Akron, Ohio, because of alleged sexual involvement with a ten-year-old boy. Further information currently being sought.

Mildly intrigued, Frank had made a note to do some checking on the man, but had not put much energy into the project until, not a month later, Ultr'ma served up a brief item on a professor of surgery from Baltimore.

Jason Mainwaring had been found to be an officer and partner in a Georgia pharmaceutical house, and subsequently had resigned his position due to charges of conflict of interest and illegal use of an unapproved drug. It had taken trips to Maryland, Georgia, Texas, and Ohio, an additional twenty thousand dollars in Ultramed-Davis funds to gather information and secure the cooperation of a certain politician in Akron, and finally, a series of the most delicate negotiations with both physicians. But in the end, Frank had forged the key to his future. And now, within the next two weeks, the rest was about to become history.

For several minutes Frank scanned the electronic roster of physicians.

He was amazed, as always, at how so many who held the ultimate ticket to success and prestige could have made such pathetic shamble@s of their lives. A pediatrician from Hartford about to complete four months in an alcohol rehabilitation center, a gynecologist from D. C. who had resigned his hospital appointment amid a cloud of accusations that his "aminations were too prolonged and included house calls, an oral surgeon facing revocation of his license for writing too many narcotic prescriptions for himself, Frank jotted down several names, along with a memo to himself to make some preliminary calls. Ultramed and its parent corporation had the clout to make any physician's background difficulties disappear to all but the most intensive investigation.

However, its administrators had been well warned against using that service indiscriminately. Frank had just terminated with Mother when, with a discreet knock, Jason Mainwaring entered the office. He was dressed in a light cotton suit, monogrammed shirt, and white topsiders, and looked very much like the plantation owner he planned to become as soon as his pharmaceutical company had successfully produced and marketed Jack Pearl's Serenyl. "Drink? " Mainwaring asked, setting his briefcase down and then striding directly to the small wet bar in Frank's bookcase. "Sure, " Frank said, quietly resenting the way the man, as always, stepped into a room and took charge. "Bourbon's fine."

The surgeon gestured at the huge aerial photo of the Ultrameddavis complex. "Nice little operation y'all have here, Frank, " he said. "I think I'm actually going to miss it some. But home is where the heart is, right?"

"Of course, " Frank countered. "Although I knew you had been up here too long when I heard a little Yankee accent creep into that drawl of yours the other day."

Mainwaring snorted a laugh as he scanned Frank's collection of cassettes. "Mantovani, Mantovani, Mantovani, " he said disdainfully, tossing them aside one at a time. "You know, the closest thing you have here to Beethoven is Mantovani."

"I like Mantovani, " Frank said. "I know."

Mainwaring thought for a moment and then snapped opein his briefcase, removed two cassettes, and flipped them onto Frank's desk. "I know I'm prob'ly tossin' pearls to a razorback, " he said, "but here are some examples of real music for you. It's what I listen to in the O. R. Call em a good-bye present. This one's Beethoven's Third. It's called the Eroica. And this one's by an English composer named Vaughan Williams.

It's a fantasia on "Greensleeves. Listen to these two pieces, and I suspect even you will appreciate the difference between real music and the Burger Mng brand you've been listening to."

"Sure thing, Jase, " Frank said, dropping the tapes into his desk drawer. "I'll start my reeducation first thing in the morning."

"I won't hold my breath." Mainwaring settled in on the sofa Frank and Annette Dolan had so recently vacated, and motioned Frank to take the easy chair opposite him. "I hate doin' business with anyone across a desk, " he explained. Unless it's yours, right? Frank thought. He hesitated, and then did as the man asked. There was no sense in making an issue of it at this stage of the game. "So, Jason, " he said. "I assume you're still satisfied."

Mainwaring took a file from his briefcase and opened it. "With this kind of money involved, " he said, "I won't be satisfied until our little anesthe ic is in every operating room of every hospital in the world.

But I am certainly pleased with the"-he consulted the file' four hundred ninety-six cases Jack and I have completed. I must say, Frank, you've done all right. You promised me five hundred cases in two years, and you delivered."

"Like I told you when we first met, Jason, I know this town."

The key to the whole project had been the rapid takeover by Mainwaring of Guy Beaulieu's practice. And only Frank, and to some extent, Mainwaring, knew how skillfully Frank had engineered that feat. Details, that's what it all came down to. Attention to touches like the letter to Maureen Banas threatening his own position should she ever disclose to anyone, including him, what was being done to her. The sort of details he had neglected to attend to three years before., Pity about ol'

Beaulieu," Mainwaring said blandly. Frank could not tell if the man was being facetious or not. Again, he opted to avoid an altercation. In the morning, Mainwaring would be gone. And in a week or so he would be back to officially tender his resignation and to offer proof of a million dollars in Frank's Cayman Islands account and half a million in Pearl's, in exchange for the patent Frank now shared with Pearl and all future rights to Serenyl. And that, Frank knew, was what it was all about. He would, at last, have squared away the $250, 000 shortfall in the Ultramed-Davis books, and there would be a nifty little bundle left over to build on. "Well, " he said dispassionately, "at least the old guy didn't suffer. When my number comes up, I want to go the same way…

So, I assume you have everything you need to conclude this business with your company in Atlanta?"

Mainwaring skimmed through his notes. "It would appear so, Frank.

Here's that, ah, little agreement you insisted upon."

He passed the document over. Frank scanned the page to be certain it included Mainwaring's admission to having illegally used Serenyl on five hundred patients. It was Frank's insurance policy against any kind of deal being made behind his back. In the morning, the two of them would jointly place the confession, along with similar ones from Frank and Jack Pearl, in a safe deposit box at the Sterling National Bank, and upon Mainwaring's return to town, the three of them would retrieve and destroy the documents together. "Remember, Frank, " Mainwaring warned,

"I don't have the final say in all this. My partners are still calculatin' what it's gonna cost us to go backward and do all the animal and clinical trials the FDA insists on, and-" Frank laughed out loud.

"Jason, please, " he said. "It costs tens of millions to develop and test new drugs that you don't even know are going to work, let alone work safety. You've got a gold mine here, and you know it, and I know it, and your partners know it, and even our little fairy friend Pearl knows it. "After five hundred perfect cases without so much as one problem, the only money you're going to spend is whatever it costs to grease a palm or two at the FDA and to put together a few folders of bogus animal and clinical trials. So don't try to shit me, okay? It's unbecoming for a man of your class."

Mainwaring shook his head ruefully. "There are a number of things I'm going to miss around here, Frank, " he said, perhaps purposely intensifying his drawl, "but I confess you won't be among them. Be sure Jack has all the paperwork and formulas ready for me in the morning, y' hear? Assumin' my partners and our chemists give their okay, I'll be back in eight or ten days. Meanwhile, I shall assume that you or Jack'll let me know if any problems crop up."

"Of course, Jason, old shoe, " Frank said. "But after two years and five hundred cases, I don't think you have to camp by the phone waiting to hear from us. Next to birth, death, and taxes, Serenyl is as close as life gets to a sure thing… And you know that, don't you."

Mainwaring's eyes narrowed. "What I know, " he said evenly, "is that this little tate-to-tate has gone on long enough."

Without offering his hand, the surgeon snapped up his briefcase and left. Not until the office door clicked shut did Frank's smile become more natural. In the interests of their deal, he had allowed the pompous ass to walk over him any number of times during the past two years. The son of a bitch even tried to tell him what music to listen to. Now, with the work completed and so successful, there was no longer any reason to defer to him, and Frank felt exhilarated that he hadn't. After years of operating in the shadows of men like Mainwaring and the Judge, it was time to start casting some shadows of his own. His life had finally turned the corner. He was a rising star in a powerful corporation, and soon he would have the independence and prestige that only money could bring. "God bless you, Serenyl," he murmured. Softly at first, then louder and louder, the familiar chant worked its way into his thoughts.

Frank, Frank, he's our man. If he can't do it, no one can… Four miles to the north, Suzanne Cole screamed and leapt up from the couch where she had been dozing. A vicious, searing pain had exploded through her chest from beside her right breast. Bathe in a chilly sweat, she tore open her blouse and ripped apart the clasps on her bra. The scar from her surgery was red, but not disturbingly so, and the tissue beneath it was not the least bit tender. Still, the pain had been like nothing she had ever experienced before. Desperately, she searched her cloudy thoughts for some logical medical explanation. Perhaps a neuritis, she reasoned-the single, violent electrical discharge from a regenerating nerve. Yes, of course, a neuritis. That had to be it. No other diagnosis made sense. Shaken, but relieved, she sank back onto the pillow. Then she checked her watch. Forty-five minutes. That was all she had napped.

She needed more than that-much more-if she was going to catch up with the sleep she kept losing every night. It was lucky she had taken time off after her surgery. The strain of the whole affair seemed to have taken more of a toll on her than she had anticipated. Slowly, her eyes closed. Perhaps she should get up and take something before she slipped off again. An aspirin or even some codeine. At least then, if the irritated nerve fired off again, the pain would be blunted. No, she decided. As long as she knew what it was, there was nothing to be frightened about. It had only lasted ten or twelve seconds, anyhow. If it happened again, she could handle it. For that short a time, she could handle almost anything. What she needed most was sleep. Relax…

Breathe deeply… Breathe deeply… Good… That's it… That's it … Now, she thought, as she drifted off, just what was it she had been dreaming about…?