Flashback

CHAPTER TWENTY-ONE

"Dr. Iverson, Mr. Iverson said to tell you that he knows you're here and will be with you as soon as he can. Are you sure I can't get you something?"

"No, no, thank you."

Zack managed to prevent himself, at the last possible instant, from augmenting his response with a shake of his head. Actually, the tympani that had been rehearsing in his brain had given way to the French horn section, and the tempest in his stomach had been downgraded to mere queasiness. Physically, it appeared, he was on the mend. With a little assistance from Cheap dog, he had awakened well before the time set on his clock radio by Suzanne. On the coffee table beside him was a glass of water, a packet of Bromo Seltzer, aild his old copy of Davenport, held open by his stethoscope and marked with a note from Suzanne which said, simply, Be strong. Now, as he waited for his brother to decide that he had been kept waiting long enough, Zack withdrew the monograph from his briefcase and reread the passage. Be diligent. Be meticulous.

Be honest. Account for every variable. Acknowledge that which you do not know, and then, at the first opportunity, learn it. Believe in yourself.

That is our system. Honor it, and it will support you like a rock. Honor it, and even the death of a patient will be no failure. Zack had been especially grateful for those words when he'd lived at the hospital that morning and been informed by his father's private duty nurse that except for his wife, the Judge was seeing no visitors, and that he had specifically included his sons in that group. Even Annie Doucette, facing surgery on her hip in twenty-four hours, was less than cordial to him. After being barred by the Judge's nurse, Zack had gone directly to her room, hoping-naively, it turned out-to be the first to tell her of what had happened. "I am not pleased with you, young man, " she had said. "You save an old lady like me, who wants to die, and then let something like this happen to a man like your father. What kind of doctor is that?"

Zack had started to respond, but then had simply shrugged and left.

Another time, perhaps. Nor was the hospital staff any more amiable.

Wherever he went, eyes were averted, greetings of any kind were mumbled or withheld altogether. Nurses and other physicians hurried in the opposite direction as he approached. He had decided to stick things out at Davis, but reestablishing himself was clearly going to be an uphill struggle. Be strong… Be strong… Be'annette, " Frank's voice crackled over the intercom, "would you please ask Dr. Iverson to come on in? And hold all calls-unless they're regarding our father's condition.

Thank you."

Zack walked into his brother's office, wishing he were anyplace else.

"Have a seat, Bro, " Frank said. "I was wondering when you were going to show up here again. Where've you been?"

"Oh, here and there. Mostly on the floor or on the toilet." know."

Zack looked at him curiously. "John Burris told me," Frank explained.

"Apparently he called to give you a progress report on the Judge. He says you were obviously intoxicated and totally incoherent."

"Aw, he was just being kind."

"Zack, this isn't funny. Burris said something about it to one nurse, and already the whole hospital knows. Once they're lost, reputations around hospitals don't get found again very often. Ask Guy Beaulieu."

"Now who's being funny, Frank?"

"You know what I meant."

"Well, one of the reasons I stopped by was to tell you that I was sorry for causing so much disruption around this place. I see now that I've got to back off a little if I'm going to get by here, even though I've only been doing what I thought was right."

"Have you?"

"Dammit, Frank, you're an excellent administrator, but that doesn't mean you're on top of everything that's going on around here."

"For instance?"

"For instance, that sleazy anesthesiologist, Pearl, and his sidekick, Mainwaring. They're up to something, Frank. They're using something other than what they say they are in the operating room. I swear it."

"That's ridiculous."

"I have proof."

"Do you?"

"Well, not exactly. But I have some data about recovery times that are pretty damn suggestive. And I've learned some things about Mainwaring's past that even you might not be aware of. I'm telling you, there's a connection between that poor Nelms kid's seizures and whatever the two of them have been giving patients in the O. R. Frank, this hospital could be headed for terrible trouble. We've got to find out what's going on."

"No, we don't, Zack-o, " Frank said simply. "What are you talking about? "

"Well, first of all, we're not going to find out because there's nothing to find out. Those two men worked here for two years before you arrived, and there was not so much as a whisper of anything but praise for either of them. How do you explain that?"

"I… I can't really. At least not yet. But I'm right, Frank. I just know I am. Mainwaring's got a past that involves testing drugs illegally, and Pearl's hiding something. Couldn't you tell that from the way he behaved last night? He's so frightened of being found out that he was willing to put that kid to sleep with anesthe ics he had never used on him in the first place. Something's going on, and dammit, I'm going to find out what."

"No, you're not, " Frank said again.

"You're not going to find out because you're not going to be stirring up any more trouble around here. And you're not going to be stirring up trouble because you're through… finished… fired. You're done at this hospital as of right now."

Zack stared at him in disbelief Frank looked back at him, smiling placidly, "Frank, that's crazy. I'm a physician on the staff. You can't fire me. Only the medical staff can do that, and then only after due process."

"Oh, really? Here, Doctor. Here are the corporate bylaws. You don't work for the medical staff. It's on page seven. Check it out. You work for Ultramed. And Ultramed can fire anyone they goddamn well please. And I'm Ultramed, and you're fired."

He held his hands out palms up. "Cest tout, mon fr amp;e. Be strong. … Suzanne's encouragement was growing hollower by the moment.

"Frank, you can't do this."

"I can, and I did. You see, Bro, that's been your big mistake all along-not understanding that this is my hospital and that I can do Whatever the hell I want to. I wanted Beaulieu out, and he was out. And now I want you out."

"Frank, you forget that even though you might not have wanted eaulieu here, you didn't fire him. He was being systematically and deliberately driven out by-"

"By who?"

Zack hesitated, remembering his promise to Maureen Banas. Then he decided that she would simply have to understand. His situation was too desperate. "It was Ultramed, Frank. He was being driven out by Ultramed.

Just look at that letter from Maureen Banas. That's proof you don't know everything that's going on around here. Do you think she wrote that of her own free will? She was coerced, Frank, by that company we work for.

By Ultramed."

"Was she?"

"Yes, she received a copy of that letter along with a note that-"

"That said if she told me about receiving it, both she and I would be fired?

" Frank's gloating leer was at once disgusting and terrifying. "Jesus,"

Zack muttered. "Nice touch, don't you think?"

"Oh, Frank. You are really sad. Why didn't you just fire him like you're trying to do to me?"

"He was an obstreperous sonofabitch, that's why. I didn't want him making a big stink. I was just learning the ropes then, Zack-o, learning how far I could go. I know them now, and they tell me that it's okay to fire you, so… you're fired.

God, I really love hearing that."

"You're crazy, Frank. Do you know that? You are absolutely nuts."

"Maybe, " Frank said. "But I am also employed. Which is more than can be said for you."

"I'm going to fight you."

Frank shrugged. "Do whatever you want. As far as the company or the medical staff is concerned, you're a drunken, disloyal troublemaker. I doubt that even your little cardiology fluff will stick up for you."

"Frank, Guy Beaulieu died because of what you did to him. Died! Doesn't that mean anything to you?"

"You have a good day, now, Zack."

"And don't you even care that it's possible some madmen are poisoning patients in the operating room of this hospital? What are you?"

"I'll be speaking with the folks at Pine Bough Realty. I'm sure they'll be more than happy to give you, oh, two or three days at least to get out of their house."

"Jesus. I'm coming to that board meeting, Frank. I'm coming, and I'm going to tell the board and Ultramed what's going on here. The Judge may be paralyzed, but he saw what Ultramed and its policies did to Annie.

He's had time to review Beaulieu's evidence and to convince people how to vote. I'm going to be there to reinforce his position."

"Well, I spoke with him earlier this morning, and he's promised to keep hands off the whole affair."

"Frank, that's a fucking lie. I was just up there. The nurse told me the Judge won't see either of us."

Frank winked. "Then let's just say that if he had spoken with me, that's what he would have promised."

"You crazy bastard, Frank… You crazy, crazy bastard."

"I'll be happy to write you a letter of recommendation, provided the place you apply to is far enough away. Now, if you'll excuse me, I have a hospital to run."

"I'll be seeing you later at the meeting."

"Try it if you want to, Zack-o.

The security guards will know exactly how to handle things if you show up there. And now, little brother, how about either you leave or I remind you of how much hurt you ended up with every time we fought behind the barn. I probably would enjoy that almost as much as I've enjoyed firing you… You take care, now. Y'hear?

" Numbly, Zack wandered from his brother's office and through the busy corridors of the hospital. The polished linoleum, the tile, the nurses bustling from one patient to the next in their starched whites, the framed prints in every room-how clean it all appeared on the surface, how perfect. The set of a movie. Zack smiled grimly at the thought.

Davis Regional had become a gleaming, movie-set hospital-Hollywood veneer with no soul. It was a nightmare. And now, a nightmare he could do no more than walk away from. He drifted into the intensive care unit.

Suzanne, wearing surgical scrubs beneath her lab coat, was in Toby's cubicle, moving about the heavily bandaged child in a way that could only mean trouble. At the foot of the bed, Owen Walsh, the pediatrician, watched, his perpetually cheerful expression darkened by concern. "Hi," she said, glancing over only momentarily. "Glad you could make it."

She studied the monitor, and then emptied the contents of a syringe into Toby's IV line. "Problems? " Zack asked. Having just been fired from the staff, he found himself strangely reluctant to approach the bedside.

"These last sixteen hours have been like a crash refresher course for me in pediatric pharmacology, " she said without looking up. "Every time his temp goes up, his rhythm goes crazy. What we're doing here amounts to nothing more than a holding action. I sure wish we knew what was going on."

I do know, he wanted to say. Instead, he forced himself to the head of the bed, where he made a quick check of Toby's pupils, eye grounds, and reflexes. While there was still no definite evidence of irreversible damage, there was certainly no sign of improvement. "We've got the promise of a bed for him in Boston, " Owen Walsh said. "But they can't transfer him until late this afternoon or this evening."

Take him away from this place, away from Jack Pearl, and you take him away from his only chance. Again, Zack's thought went unspoken.

"Anything I can do in the meantime? " he asked. "You can review the steroids he's getting." Suzanne checked the temperature reading from the rectal probe. "Back down to one-oh-two. And look, Zack-his rhythm's stable again. Damn, what's going on?"

"If you're able to leave, " he said, "I'd like to talk to you for a minute."

Suzanne checked the monitor and Toby's chest, and then glanced over at Walsh. "Just don't go too far, " the pediatrician said. "We'll be right outside in the waiting room, Owen, " she replied. "Besides, you're doing fine here."

Walsh smiled. "She saves this child's life at least five times in one night, and she says I'm doing fine."

"Nonsense. I'll be back in a little bit. Hang in there."

As soon as the door to the ICU waiting room clicked shut, Suzanne threw her arms about Zack's chest and buried her head against his shoulder. "I knew you'd come back, " she said. "I'm so damn proud of you of both of us. Listen, as soon as we get Toby off to Boston, let's go to my place for dinner. Helene's going to take Jen for the night, and I have a batch of shrimp in the fridge and-"

"Suzanne-"

"No, listen, it's my guilt for acting the way I did in the E. R. last night, and only shrimp sauteed in garlic butter will-" He held her by the shoulders and moved her away. "Suzanne, Frank just fired me."

"He what?"

"Effective immediately."

"He can't do that."

"Can and did. He even was kind enough to present me with a set of the corporate laws to prove he can."

He held up the book for her to see. Only then did he realize how totally drained she looked. Her face was pale and drawn, her eyes reddened with strain and fatigue. "This is crazy, " she said. "What reason did he give?"

"Actually, according to page seven here, he doesn't need a reason. But just to be fair, he provided a couple, being drunk while on call technically, I was, you see-being a disruptive influence. Hell, I can't even remember everything he said. Listen, you look really wasted. Why don't you find an empty bed and crash for an hour or two? I'll watch Toby. Frank won't even know I'm in the hospital. And even if he finds out, he won't do anything about it. Owen's too panicked about being left alone to allow that. We'll talk later, after we get the child to Boston."

"No, Zack. I'm fine. Really." she said. "But Zack, we can't let him do this,"

"You don't understand. This isn't a hospital the way we were trained to know one. It's a merchandise mart that hires doctors and nurses and technicians. And Frank is the president to that company-at least here in Sterling he is. He hires, and he can fire. Except with someone like Guy Beaulieu. In Guy's case, Frank didn't want the hassle Beaulieu was threatening him with, so be just took the route of destroying the man by rumor and innuendo. He admitted being responsible for all of that." 66 TO you?"

"He had already fired me. What did he have to be afraid of? He was actually boasting when he told me."

Suzanne sank onto the sofa. "Oh, Zack, " was all she could manage.

"Listen, Suze, this is my problem, and I'll work it out."

"No, " she said suddenly' whatt' "No, it,s not your problem-at least not yours alone. It's all of ours. The medical staff, I mean. We're going to fight this."

"Suzanne, I don't want anyone else getting hurt because-"

"No,)isten to me. For years now, at least as long as I've been here, the doctors in this hospital have been acting like… like ostriches.

This isn't the first time there's been a problem between Frank or Don Norman and staff doctors, Zack. It isn't the first time one of us has clashed with the system here and then suddenly found himself out. Don't you remember what Wil Marshfield said that first night? And I've been as much of an ostrich as anyone-so grateful for getting out of the trouble I was in that I've turned my back on any number of company decisions that might not have been in the best interests of our patients. I didn't feel committed enough to any one issue to make waves. But dammit, I feel committed now."

"Suzanne, I don't want you-"

"Please. You had the guts to come back and face the music. And now, dammit, I'm going to see to it that the medical staff gets behind you.

It's time we stood up for this community-time that we stood up for our own… She rose and took his hands. "Zack, hang in here. Please. Do it for all of us. If I can just get us to present a unified front, I'm sure the medical staff can stand up to the coq@oration. And if we can't get Ultramed to listen, then… then we'll just take our case to the community."

"You think you could pull that off? " he asked. "I'm tougher than I look." He touched her cheek. "That's not saying much, you know."

"Well, you just watch. Can you stand the heat? "

"Suzanne, I don't want to leave here. I don't want to leave you."

"Okay, then. It's decided. As soon as I finish with my office appointments, I'm going to start twisting some arms."

"It's not going to be easy."

She kissed him lightly. "It's not going to be as hard as you think.

Listen, I ought to get back in there. What are you going to do right now?"

"I think I'm going to try and get in to see my father.

He refused to see me earlier, but I think it's worth one more try.

I was planning on putting in an appearance at that board meeting later today, but Frank has promised to have the hospital security people ready for me if I do."

"Damn him. Zack, I think your brother and I are about due for a little meeting of the minds."

"You would do that?"

"Would and will. I have too many friends around here, and make too much money for this place for him not to listen to me. You must be strong..

.. God, Zachary, it feels so good to realize that all of a sudden I'm not afraid anymore."

"You were afraid of the corporation?"

"No, " she said, kissing him once again. "Of you."

Brief operative note (full note dictated),… Four-inch gash over T-10, 11, and 12 debrided… hemostasis attained… wound explored…

Jagged five centimeter by three centimeter piece of rusty metal removed without difficulty… dura appears intact… No collection of blood noted… Wound irrigated copiously, and then closed with drain in place … Patient sent to recovery room in stable condition, still unable to move either lower extremity… Tetanus and antibiotic prophylaxis initiated… Preoperative impression, foreign body, low midback, postoperative impression, same, plus paraplegia-etiology uncertain, possibly secondary to spinal cord disruption or circulatory embarrassment… Seated to one side of the nurses' station, Zack read and reread the account of his father's surgery, and confirmed through John Burris's terse progress note and two much more detailed nurse's notes, that there had been little change in the Judge's condition since his surgery. Dura intact… No collection of blood… Zack chewed on the nub of his pen as he stared out the window at the Presidential Range. Something was off. The Judge's symptoms seemed out of proportion to the extent of his injury-way out of proportion. The pieces of this clinical puzzle simply weren't locking together. Sheering forces snapping fibers in the cord, arterial spasm with enough interruption of blood supply to cause nerve damage-there were a number of logical explanations for the Judge's paraplegia, but none of them sat just right. At one end of the Formica counter, a small plastic tray was piled high with pens and pencils, as well as a stethoscope and several other pieces of medical equipment. Zack slipped an opbthalmoseope, reflex hammer, and straight pin into his pocket and headed for his father's room. It wasn't that he was questioning Burris's findings and opinion, he rationalized, it was just that… that a physician was taught never to completely trust anyone's findings or conclusions other than his own, Now, if he could only get the Judge to allow him close enough to do an exam… Cinnie Iverson was seated on a low, hard-backed chair id the hallway outside of her husband's room. She was, as always, dressed immaculately-this day in a plain blue dress, with a white cardigan draped over her shoulders. Lipstick and an ample amount of rouge failed to completely obscure her pallor. Her ever-present lace handleerchief was balled in one fist. "Hello, Mom, " Zack said as he approached, She stood, and allowed him to kiss her on the cheek. Her expression was cool, but not angry, which was to say, as disapproving as Zack had ever known it to be. "How's he doing? " he asked. "The nurse is giving him a bed bath."

"Any change?"

Cinnie Iverson bit at her lower lip and shook her head. "Mom, I… I'm sorry this has happened. You can't know how terrible I feel."

"I'm sure you do, " she said quietly. "We all do. She hesitated, then went on. "Zachary, I'm quite sure that in time I'll see things more charitably, but right now, with the Judge lying in there like that, you'll have to forgive me if-"

"I understand," he said. "All I want you to know is the same thing I came up here to tell him, and that is that I was only trying to do what I thought was right."

"I believe that. I don't think he'll speak with you, though, " she added. "He's very upset-at everybody. And he's very depressed."

"He doesn't have to speak, Mom. He just has to listen. Who sent the flowers?"

He motioned toward an enormous vase of lilies, orchids, and birds of paradise that he estimated must have cost one hundred fifty dollars — probably even more. "It just arrived from Frank, " she said. "Whether you know it or not, you owe your brother quite a thank-you. He was very helpful in keeping us all under control last night. Very helpful."

"I'll… I'll thank him just as soon as I can, Mom."

"I just don't know what we would have done without him."

She dabbed her handleerchief at the corner of one eye. "I understand,"

Zack said, fighting off a wave of rage. "I only wish Lisette were around. At least then I'd know he was getting a decent meal once in a while."

"He told you about Lisette?"

"He told me she and the girls are in Virginia visiting an old friend of hers, if that's what you mean."

"Sure, Mom, " Zack said through nearly clenched teeth. "That's what I meant."

At that moment, the private duty nurse, an expansive woman with pendulous upper arms and thick ankles, wheeled her cart from the room.

"He's all set, dear, " she said. "Sorry to take so long, but that husband of yours is a big man…" She eyed Zack warily. "Still no visitors, Doctor, " she said. "I'm sorry."

"Mom, I need to go in to talk to the Judge."

Cinnie took a moment to size up the exchange. "It's okay, Mrs. Caulkins,

" she said. "I'll take care of things here. You go do whatever it is you have to." She waited until the woman had gone. "Zachary, I'll ask your father if your visit would be okay, but I don't expect him to say yes."

"Mom, it's important-very important that I speak with him."

She hesitated. "Mom, please "You won't say anything to upset him? "

"Promise."

"Well, then, I suppose you should be allowed to go in there and say your piece."

"Mom, thank you."

"Arid Zachary? " She continued to work her handleerchief over and over in her hands. "I know you didn't mean things to turn out this way."

"That's right, Mom," he said, knowing that she would miss the understatement-the sad irony id his voice. "I certainly didn't."

Muted sunlight, filtering through the nearly closed blinds, provided the only illumination in the room. The Judge, wearing a blue hospital Johnny, Jay on his back, staring at the ceiling. An intravenous line was draining into one arm. "Hello! Judge, " Zack said. Clayton Iverson glanced over at him, and then looked away. "Are you in much pain?"

There was no response. "Judge, it won't hurt to talk to me. Believe me, it won't… Okay, okay, suit yourself."

It might have been a mistake to have come. Zack could see that now.

Merely going against the man's wishes was enough to warrant the silent treatment, let alone going against his wishes and achieving such disastrous results. He reminded himself that the Judge could be as petulant and inflexible as Frank. Zack turned to go, but then he stopped. There were things he had to get out-if not for his father, then for himself. "Okay, Judge, you don't have to say a word. I won't stay long. I just wanted to tell you that I feel very badly for the way things have turned out. I was only doing what I spent so many years training to do-using my judgment, and trying to do my best."

He pulled a chair over as he spoke, and sat down by his father's hand.

The Judge continued to stare at the ceiling. "Judgment, Dad… that's what you have to rely on, too, now that I think about it. Maybe in time, that will help you understand the dilemma I was in… "Judge, you're my father. I love you for that-for the things you've done for me, for the kind of person you've helped me become. I would never want to see you hurt. Never. I honestly believe that I would give up my life, if necessary, to protect you. But that's my life… "Anyhow, I guess what I really want you to know is that although I'm sorry as hell for the way everything turned out, given the information I had to work with last night, if the same situation arose again, I would make the same choices.

That's the sort of person my parents raised me to be, and the sort of surgeon I was trained to be. I came up here to ask for understanding, not absolution."

He paused, hoping for some sort of reply. There was none. In that moment, he decided to say nothing of what had transpired with Frank.

Soon, the Judge would learn it all anyhow, but this was not the time to attack the man's myth of his quarterback son. "Well, then, " he said. "I guess that's that." He rose. "Oh, except for one other thing. I'm going to that meeting today to present Guy's case to the board. I don't expect to sway many votes, but I think Guy was right. I think we need to take a hard look at what we're willing to give up in exchange for a few shiny pieces of equipment and some black ink on the bottom line. So if you could just talk to me enough to tell me where that folder of his is, I'll-"

"It's gone, " Clayton Iverson said flatly, still not looking at his son.

"What!"

"I said the folder is gone. I… I gave it to the Ultramed people to examine. They have it. Now please, go."

Zack sighed. "You certainly underwent one heck of a change of heart there, Dad, " he said. "I asked you to leave."

"I'm going. I'm going."

As he turned, Zack's hand brushed against the instruments in his pocket.

He hesitated, took several steps toward the door, and then turned back.

"Judge, I know you want me out of here, " he said, "but… but I'd like to examine a couple of things on you if I could before I go."

Tentatively, he returned to the bedside, waiting for the man's outburst.

There was none. He lifted the sheet off his father's legs. "Thank you, Dad, " he whispered, gauging the muscle tone of one calf with his fingertips. "Thank you for trusting me this much. This will only take a minute."

In fact, Zack's examination, carried out mostly with his touch and reflex hammer, took just over five minutes. Clayton Iverson watched him work in stony silence, although there was a spark of curiosity in his eyes. By the time Zack had finished, by the time he had dropped down on a corner of the bed, shaken and mentally drained, the loose-fitting pieces of the clinical puzzle had been pulled apart and rearranged in the strangest of patterns. "Mom, can you come in here, please?" he called out, after he had regained some composure. "There's something I want both of you to hear together."

Cinnie Iverson entered, took the chair next to the Judge, and held his hand. Zack paced from one side of the room to the other, choosing each word carefully, suddenly frightened that the tendon and muscle activity he had detected were not true neurologic indicators at all, but rather the phantoms of his own hopes. "Judge, Mom, " he began, "have either of you ever heard of a conversion reaction?"

Cinnie Iverson shook her head. Clayton did not move. "An older term for it was conversion hysteria, but I never liked that phrase, because hysteria implies craziness, and a conversion reaction is much more an intense, involuntary focusing of emotional energy than it is a sign of anything crazy."

"Zachary, what are you saying?

" Cinnie asked. "I'm saying that there are certain reflexes that disappear when the spinal cord is damaged, and others that show up. The pattern I'm finding now isn't consistent with that."

"I'm not sure I understand, " Cinnie said. "Judge, I know this may not make total sense to you at the moment, but I'm picking up signs-fairly strong signs-that your paralysis may be due to factors other than spinal cord damage-emotional factors."

"Emotional factors?"

Cinnie sounded incredulous. The Judge showed no reaction at all. "I know it sounds far out, " Zack said, "but believe me, it isn't. It happens all the time. One of my first cases on my neurology service was a man with psychologically induced blindness. There was absolutely nothing wrong with his eyes, yet he positively couldn't see. In fact, after hypnotherapy, much of his vision returned. "Heart attacks in Type A personalities, gastric ulcers in situations of high stress-our emotions have power over every organ in our bodies. There's even a well-documented condition called pseudocyesis in which a woman who desperately wants to become pregnant has her periods stop, her breasts grow large, and her abdomen swell. Only a blood test or an ultrasound or X ray can prove she's not pregnant."

"And you think your father may be having one of these-what are they called?"

"Conversion reactions. Yes, Mom, I do. Judge, your neurologic findings simply don't jibe well with any other explanation." The Judge looked away. "But why? " Cinnie asked. Zack shrugged. "I'm not certain, " he said. "Anger at me is the most likely possibility. There are other factors that could be at work, too, I guess, fear, grief, guilt. Only you can fill in the blanks, Judge. But whatever it is, isvery powerful stuff. At the moment, even you might not know. Many times, though, as soon as the source of the conversion is identified, the symptoms begin to resolve."

"Are you sure about this? " Cinnie asked. "No, Mom, I'm not. It's just that the other diagnoses don't fit with the operative findings and Dad's clinical picture, and conversion reaction does. I might be wrong. All I can do is hope that I'm not, and tell you what I think."

"Clayton? " she asked. The Judge, tight-lipped, would not answer.

"Zachary, " she said, "perhaps you'd better go now. We can talk about this again soon." She rose and kissed him on the cheek, her expression begging him to leave them be-to allow them the chance to digest what he had said. "Sure enough, " he said. "When is the ambulance due?"

"Any time now, I think."

"Fine… Dad, I-" He looked down at his father's pallid, emotionless face. "I'll be thinking of you."

As he reached the doorway, Zack checked the corridor for his brother or a security guard, and then headed for a room at the far end of the hall.

If, as it seemed, he was running out of time within the walls of Ultramed-Davis, he would use what little he had left to make one last run at a clinical puzzle that was no less perplexing than his father's, and far more lethal. "I knew it, " Barbara Nelms said as Zack finished recounting his interview with her son and the theories he had developed as a result. "You are not a very good liar, Dr. Iverson. I could see it in your eyes that night in your office. I should have called you on it then, dammit. You know, holding out on me like that was a very cruel thing to do."

"I know, and I'm sorry, But I had no proof."

"Dr. Iverson, Toby is my son."

"I understand."

Barbara was propped up in her hospital bed by several pillows. Her right arm was in a sling and her left was fixed to an intravenous line that was infusing a potent antibiotic. Despite her pallor and the heavy shadows engulfing her eyes, her glare was piercing. "I'm not sure that you do, Dr. Iverson, " she said after some thought.

"But I'm willing to give you the benefit of the doubt-at least for now."

"Thank you."

"You said that you held back information from me and my husband because you had no proof of your theories. Am I to assume that situation has changed?"

Zack hesitated. "Dr. Iverson, please, " she said. "Don't try to lie to me again. My son nearly stabbed me to death yesterday without even knowing I was there."

"Okay, " he said. "Okay. The truth is, as things stand, I have no direct proof of anything. But the circumstantial evidence supporting my belief is quite strong-at least to me it is."

"Tell me." Zack reviewed his impressions of Pearl and Mainwaring's gallbladder cases, and summarized his conversation with Tarberry at Johns Hopkins. He could see the anger smoldering in Barbara Nelms's eyes. In time, whether Toby survived or not, she would be out for blood.

And where once that notion had been the impetus to have him lie to her, now it goaded him to share every detail. Frank had been given his chance to clean house, but he had ignored it. "I wouldn't blame you a bit for being skeptical, " Zack said as he concluded his account, "but that's the way I see it."

"Dr. Iverson, " Barbara Nelms responded, her fury barely contained,

"this is the first time since this nightmare began that an explanation has fit with the facts as I know them. I believe every word you've told me. Every word."

She turned and stared out the window. Resting on the rim of her sling, her fist was clenched. Slowly, her fingers relaxed. The tension in her neck and back lessened. When she turned back to Zack, the anger had given way to determination. "Now then, Dr. Iverson, " she said, "what can we do to save my son?"

Zack took a moment to sort his thoughts. "Well, first of all," he said finally, "it would help tremendously if we could find the trigger."

"You mean the thing that sets Toby off?"

"Exactly."

"But how?"

"I want you to close your eyes, lean back, listen to my voice, and begin to tell me everything you can think of surrounding Toby's attacks.

Everything, no matter how trivial it may sound."

"Are you going to hypnotize me?"

"I can. And I will, if it seems appropriate. But I believe all you'll need is a little help. Now, relax as much as you can, open your mind, and let it drift back to Toby's very first episode."

"He… he was in his pajamas. "Good. Go on."

"It was before bed… He was playing… "Playing what?"

"I. I can't remember."

"Was he in his room?"

"Yes… No, no, wait. He ended up in his room, but I don't think he started there. He… he was in the den. He was watching television.

Yes, that's right. That's exactly right."

"Good. Very good. Now, what was he watching?"

"The show?"

"Yes."

"I… I can't remember."

"Just relax, Barbara. You're doing fine… Now, just open your mind to that evening and think about what he might have been watching… See it … Just relax, open your mind, and see it… The muscles in Barbara Nelms's face went slack. Her breathing became deeper and more regular.

"That's good, " Zack whispered. "That's very good."

Zack's words brought a strange, enigmatic smile to Barbara's mouth. "I know what he was watching, " she said. "Each time, I know what he was watching…"