Flashback

CHAPTER TWO

The three of them, father and sons, sat alone at the table. Outside, the storm clouds had arrived, bringing with them a premature dusk. The women were in the kitchen, Annie in the breakfast nook, Cinnie and Lisette by the sink, loading the dishwasher for the second time, chatting about the upcoming Women's Club bake sale, and keeping watch on the twins, who had taken Cheap dog out back to play in the meadow. In a manner quite consistent with his belief that business matters and women should be separated whenever possible, the Judge had kept the conversation light until the last of them, Annie, had left the room. Then, after a few sips of coffee, he turned abruptly to Frank. "Guy Beaulieu came to see me yesterday, " he said. "So?"

"He says Ultramed and that new surgeon, Mainwaring, have just about put him out of business at the hospital."

"Jason Mainwaring's not new, Judge, " Frank said patiently. "He's been here almost two years. And no one-not him, not Ultramed, not me, not anyone-is trying to put Beaulieu out of business. Except maybe Beaulieu himself. If he'd be a little more cooperative and a little more civil to people around the hospital, none of this would be happening."

"Guy's a crusty old devil, " the Judge said, "I'll grant you that.

But he's also been around this town nearly as long as I have, and he's helped a lot of folks."

"What's all this about? " Zack asked. The Judge was hardly a spontaneous man, and Zack could not help but wonder if there was a reason he had postponed this conversation through four hours of golf to have it now.

Frank and the Judge measured one another, silently debating whose version of the story Zack was to hear first. The contest lasted only a few seconds. "A short while back, " the Judge began, obviously unwilling openly to concede Frank's "almost two years,"

"Ultramed-Davis brought a new surgeon into town, this Jason Mainwaring."

"I met him, I think, " Zack said. He turned to Frank. "The tall, blond guy with the southern drawl? " Frank nodded. Zack remembered the man as somewhat distant, but polished, intense, and, during their brief contact, quite knowledgeable-more the type he would have expected to see as a university medical-center professor than as a mountain community-hospital general surgeon. "Well, " the Judge went on,

"apparently Guy was already beginning to have some trouble getting a lot of his patients admitted to the hospital."

Frank sighed audibly and bit at his lower lip, making it clear that only courtesy kept him from interrupting to contest the statement. "More and more, his patients-especially the poor French-Canadian ones-were being shipped to the county hospital in Clarion. Then rumors started floating around town about Guy's competence and all of a sudden, all the surgical cases who could pay-those with insurance, or on Medicaid-were going to this Mainwaring. I've heard some of the rumors myself and, let me tell you, they are vicious. Drinking, doing unnecessary internal exams on women, taking powerful drugs because of a small stroke…"

"Is there truth to any of them? " Zack asked. During the summer between his sophomore and junior years at Yale Med, he had worked as an extern at the then Davis Regional Hospital, and Beaulieu had gone out of his way to bring him into the operating room and to nurture his growing interest in surgery. It was a concern he had never forgotten. The Judge shook his head. "According to Guy, there have been no specific complaints from anyone. Just rumors. He says that about eighty percent of his work now is charity stuff at Clarion County, and that he hasn't operated on a non-French-Canadian patient at Ultramed for almost a year.

He says the whole thing is a conspiracy to get back at him because he was so opposed to the sale of the hospital to Ultramed in the first place."

"That's ridiculous, " Frank said. "Mainwaring's getting the cases because he's good and he works like hell. It's as simple as that. You know, Judge, I don't think it's fair for you to take Beaulieu's side in this thing."

Clayton Iverson slammed his hand down on the table. "Don't you ever dare tell me what's fair, young man! " he snapped. "The provisional phase in our contract with Ultramed still has a month to run. I convinced the board of trustees to sell out to them in the first place, and by God, the three weeks until our meeting and vote is more than enough time for me to convince them to exercise our option and buy the damn place back."

He breathe deeply and calmed himself. Zack glanced over at Frank. Though he was staring at their father impassively, his hands were clenched and his knuckles were bone-white. "And let me make this clear, " the Judge went on, "I haven't taken anyone's side. As a matter of fact, Frank, I resented his implications that you were in any way involved with his problems, and I told him so. He apologized and backed off some, but he's hurt, and he's angry.

I promised him I'd speak to you-both of you-about it… ask you to keep your eyes and ears open. I feel we owe it to him. You were too young to remember, Frank, but that man all but saved your life when your appendix burst."

Frank's fists relaxed a bit, though Zack could tell that he was still smarting from the Judge's threat. Personality clashes, power plays, and political machinations were, he knew all too well, as omnipresent and as integral a part of hospital life as IVS and bedpans. But he sensed something more to all of this-something virulent. "Annie!"

Cinnie Iverson's cry was followed instantly by the crash of dishes. With reflexes born of years of crisis, Zack was on his feet and headed toward the kitchen as Frank and the Judge were just beginning to react. Annie Doucette was on the floor. Her back and neck were arched, and her limbs were flailing uncontrollably in a grand mal seizure. As Zack knelt beside the woman, he felt the change sweep over him.

Early on, he had heard about the phenomenon from other, older docs, but did not undergo it himself until midway through his second year of residency, when he witnessed the cardiac arrest of a patient. In that moment, his world suddenly began to move in slow motion. His voice lowered and his words became more measured, he sensed his pulse rate drop and all his senses heighten. It was unlike anything he had ever experienced in similar emergencies. Movements became automatic, observations and orders instinctive. Dozens of facts and variables were processed instantly and simultaneously. Later, with the patient successfully resuscitated and stabilized, he would learn from the nurses that he had acted quickly, decisively, and calmly. It was only after hearing their account of his performance that he realized fully what he had done. The change had been part of him ever since. "Mom, call an ambulance, please, " he said as he rolled Annie to one side to prevent her from aspirating her own stomach contents, should she vomit. His fingertips were already at the side of her neck, feeling for a carotid pulse. As the change intensified, all sense of the woman as a friend, a loved one, a patient, yielded to the objectivity of assessment. If it became necessary, in any way, to hurt in order to heal, then hurt he would. "Frank, my medical bag is in a large carton at the back of the van. Could you get it, please? " Please. Thank you. The use of these words during a crisis kept everybody calmer, including, he suspected, himself. Stroke, heart attack with arrhythmia, epilepsy, sudden internal hemorrhage causing shock, hypoglycemia, simple faint mimicking a grand mal seizure, the most likely diagnostic possibilities flowed through his mind, each accompanied by an algorithm of required observations and reactions. Annie's color was beginning to mottle. Her back remained arched and her arms and legs continued to spasm. Her jaw was clenched far too tightly to slip any buffer between her teeth. Again and again, Zack's fingertips probed up and down along the side of her windpipe, searching for a pulse. She had had chest pain at the table. Zack felt certain of that now. Heart attack with an irregular, ineffective beat or complete cardiac standstill moved ahead of all other possibilities in his mind. "Judge, are you okay to come down here and help? Good. I'm going to put her over on her back. If she starts to vomit, please flip her back on her side, regardless of what I'm doing. Lisette, check the time, please, and keep an eye on it."

Zack eased the woman onto her back. Her seizure was continuing, though her movements were becoming less violent. Again he checked for pulses, first at her neck, then in each groin. There were none. He delivered a sharp, two-fisted blow to the center of her chest and began rhythmic cardiac compressions as Frank arrived with his medical bag. "Judge, please fold something up and put it beneath her neck, then lay that chair over and put her feet up on it if you can. That's it. Frank, there are some syringes with needles already attached in the bottom of the bag. I need two. Also, there's a little leather pouch with vials of medicines in it. I'll need Valium and adrenaline. That one may say 'epinephrine' on it. Mom, did you get the ambulance? Good. How long?"

"Five minutes at the most."

"Frank, can you do CPR?"

"I took the course twice."

"Good. Take over here, please, while I get some medicine into her to stop her seizing. Don't bother trying mouth-to-mouth until she stops.

Just pump. You're doing fine. Every one's doing fine." Zack placed his fingertips over the femoral artery. "A little harder, Frank, please," he said. "Time, Lisette?"

"Just over a minute."

Without bothering with a tourniquet, Zack injected Valium and adrenaline into a vein in the crook of Annie Doucette's arm. In seconds, her seizure stopped. Frank continued pumping as Zack hunched over the woman and administered half a dozen mouth-to-mouth breaths. Moments later, Annie took one on her own. "Hold it, Frank, please, " Zack said as he searched, once again, for a cartoid artery pulse. This time he felt one-slow and faint, but definite. He checked in her groin. Both femoral artery pulses were paldable.

I. N Again, the woman took a breath, then another. Come on, Annie, his mind urged. Do it again. Just one more. Just one more. He slipped a blood pressure cuff around her arm and then worked his stethoscope into place with one hand while he returned his other to the side of the woman's neck. "I hear a pressure, " he announced softly. "It ain't much, but for right now, it's enough."

Annie's breathing was still shallow, but much more regular. Softly, but steadily, she began to moan. Her lips were dusky, but the terrible mottling of her skin had lessened. At that moment, they heard the whoop of the ambulance, and seconds later, strobelike golden lights appeared in the living room window. Zack looked up at his older brother, who knelt across the woman from him. For an instant, he flashed on two young boys kneeling opposite one another in a dusty, vacant lot, shooting marbles. For ten seconds, twenty, neither man moved or spoke. Then Frank reached over and took his hand. "Welcome to Sterling, " he said. THE AMBULANCE WAS one of several well equipped vans owned by Ultramed-Davis and operated by the Sterling Fire Department. Zack sat beside Annie in the back, watching the monitor screen as the vehicle jounced down the narrow mountainside road toward the hospital. A young but impressively efficient paramedic knelt next to him, calling out a blood pressure reading every fifteen or twenty seconds. Sterling, New Hampshire, was small in many ways, but Zack could see Ultramed's influence in the emergency team's response. This was big city medicine in the finest sense of the term. Annie was still unconscious, although her breathing seemed less labored and her blood pressure was inching upward. "Eighty over sixty, " the paramedic said. "It's getting a little easier to hear."

Zack nodded and adjusted the IV which the young man had inserted flawlessly, and even more rapidly than he himself could have done. Frank had stayed behind to tend to the family and contact a cardiologist. They would meet later at the hospital. Zachary felt tense, but he was also charged and exhilarated. When it all came together, when it all worked right, there was no comparable feeling. Come, Watson, Come! The game is afoot. Zack loved the quote, and often wondered if Arthur Conan Doyle, a physician, had transferred the energy of his experience with medical emergencies to his detective hero. After a brief stretch on the highway, the ambulance slowed and turned into the long, circular driveway leading uphill to the hospital. A large, spotlighted sign at the base of the drive announced, ULTRAMEDDAVIS REGIONAL HOSPITAL–COMMUNITY AND CORPORATE AMERICA WORKING TOGETHER FOR THE BETTERMENT OF ALL. Zack smiled to himself and wondered if he was the only one amused by the hubris of the pronouncement. The Betterment of All. Ultramed Hospitals Corporation and Davis Regional Hospital could certainly never be accused of setting their sights too low. Still, although he had a few lingering concerns about working for a component of what some had labeled the medical-industrial complex, his conversations with Frank and the Judge, and his investigations of the hospital and its parent company, had provided no cause to doubt the proclamation, however audacious.

Ultramed-Davis, now a modern, two-hundred-bed facility, had a proud history dating back to the turn of the century, when the Quebecbased Sisters of Charity placed ten beds in a large donated house and named it, in French, Hopital St. Georges. Over the decades that followed, brick wings were added, until, ultimately, the old house was completely replaced. The hospital's capacity grew to fifty patients, and eventually, to eighty. In 1927, the St. Georges School of Nursing was established, and before its closing in the early seventies, produced more than 350 nurses. In mid-1971, the ownership and administrative control of St. Georges was transferred from the Sisters of Charity to a community based, nonprofit corporation headed by Clayton Iverson, already a Clarion County circuit judge, and was renamed after Reverend Louis Davis, the pastor who had donated the initial structure to the town. Over the years that followed, a succession of inadequate administrators, most of them using Davis Regional as a stepping-stone to bigger and better places, made a succession of unfortunate decisions, opting too often for projects and personnel additions that looked progressive but could not support themselves financially. Gradually, but inexorably, community support for the facility dwindled, and benefactors became scarce. Older physicians began retiring earlier than they had planned, and a lack of financial inducements kept young recruits from taking their places. Bankruptcy and closure became more than theoretical possibilities. It was then, with the wolves howling at the hospital door, that the Ultramed Corporation appeared on the scene. A subsidiary of widely diversified RIATA International, Ultramed assailed the hospital board with slide shows, brochures, stock reports, pasteboard graphs, and more financial information on the facility than even the most diligent trustee possessed. Suspicious of outsiders and wary of losing control of an enterprise that had, for most of a century, been at the very heart of their community, a majority of the board opposed the sale, favoring instead another bond issue and one more stab at doing things right. Clayton Iverson, citing what he called "the bloodred writing on the wall, " knew the community had no sensible alternative but to sell.

By his own spirited account, he worked his way through the trustees one by one, cajoling, arguing, calling in markers. In the end, Zack had been told proudly, the vote was unanimous. Unanimous, that was, save one Only Guy Beaulieu remained opposed, though out of respect for the Judge he declined to vote at all. Never one to relinquish power with a hook, the Judge extracted two concessions from the corporation in exchange for the sale of the hospital, a provisional four-year period after which the board of trustees could repurchase the facility, including all improvements, for the original six-million-dollar price, and the serious consideration of his son for the position of administrator. As near as Zack could tell from his father's account, following an exhaustive series of interviews, Ultramed had selected Frank over dozens of applicants-most with extensive hospital experience. That decision, for whatever reasons it was made, had proved brilliant. Orchestrated by Frank, and aided by time-tested business practices and public relations techniques, the turnabout in the hospital was immediate and impressive.

New equipment and new physicians underscored the corporate theme of "A Change for the Better, " and the remaining opponents of the facility-mostly in the poor and uninsured sectors of the community-experienced increasing difficulty in finding a platform from which to voice their concerns. In just a few years, Ultramed-Davis Regional Hospital had been transported from the backwater of health care to the vanguard. "Hang on, Doc, " the ambulance driver called over his shoulder to Zack. "We're here."

Zack braced himself against Annie's stretcher as the man swung a sharp turn and backed into the brightly lit ambulance bay. Alerted by the ambulance radio, a team of three nurses dressed in blue scrubs and an orderly wearing whites was poised on the concrete platform. Before Zack could even identify himself, two of the nurses, with tight-lipped efficiency, had pulled Annie's stretcher from the ambulance and sped past him into the emergency ward. Zack followed the stretcher to a well-equipped room marked simp1Y, TRAUMA, and watched from the door as the team transferred Annie to a hospital litter, switched her oxygen tubing and monitor cables to the hospital console, and began a rapid assessment of her vital signs. One nurse, apparently in charge, listened briefly to Annie's chest, then took up a position at the foot of the bed, supervising the evaluation. "Excuse me, " Zack said to the woman, who wore a white lab coat over her scrubs. "Could I speak to you for a moment?"

The woman turned, and Zack felt an immediate spark of interest. She was in her early thirties, he guessed, if that, with short beach-sand hair, fine, very feminine features, and vibrant, almost iridescent, bluegreen eyes. Instinctively, and quite out of character for him given the situation, Zack glanced at her left hand. There was no ring. "I… I'm Dr. Iverson, Zachary Iverson, " he said. Had he actual stammered? "I'm a neurosurgeon due to start on the staff here tomorrow. That woman we just brought in is… I mean was… sort of like my governess when I was young. Mine and my brother Frank's."

"Now there's a name I recognize, " the woman said, cocking her head to one side as if appraising a painting in a museum. "Yes, " Zack said.

Several seconds passed before he realized that he had not yet finished explaining what he wanted. He cleared his throat. "Well. Frank said he would arrange for a cardiologist-a Dr. Cole, I think he said his name was-to come in and take over Annie's care. Has he arrived yet?"

"No, " the woman said thoughtfully. "No, he hasn't, Doctor."

Her expression was at once coy and challenging, and Zack, often oblivious to women's attempts at nonverbal interplay, felt ill-equipped to respond with an expression of his own. "I see, " he said finally, wondering if he was looking as flustered and restless as he was feeling.

His ego was goading him to be assertive-to remind the woman that, while he might have momentarily been taken aback by her, he was, at least until the arrival of Dr. Cole, in charge. He cleared his throat again and, unconsciously, stood more erect. "Well, then, " he went on, with a bit more officiousness than he had intended, "would you please have someone call him again. I'll be in there with Mrs. Doucette. Just send him in as soon as he gets here. Also, could you order an EKG and a portable chest X ray."

"Certainly, Doctor, " the woman said as he strode past her and into the room. Bravo, his ego cheered. Well handled. He glanced back over his shoulder. The woman had not yet moved. "Could you call the lab, too, please, " he ordered, wishing her eyes would stop smiling at him that way. "Routine bloods."

"Certainly, " she said. "Cardiac enzymes, too?"

Damn her cool, Zack thought. "Yes, of course, " he responded. "Have them draw extra tubes as well. Dr. Cole can order whatever else he wants when he gets here."

He walked to the bedside without waiting for an acknowledgment of his request, and forced himself not to look back. Annie's eyes, still closed, were beginning to flutter. "I'm Dr. Iverson, " he said to the two nurses who were attending her. "How's she doing?"

"Her pressure's up to a hundred over sixty, " one of them, a husky, matronly woman in her fifties, said. "She's moved both arms and both legs, and it looks like she's about to wake up."

"Good, " Zack said, aware that a portion of his thoughts, at least, were not focused on the matter at hand. He slipped his stethoscope into place and checked Annie's heart and lungs. "Annie, it's Zack," he said into her ear. "Can you hear me?"

Annie Doucette moaned softly. Then, almost imperceptibly, she nodded.

"You passed out, Annie. You're at the hospital now and you're going to be all right. Do you understand that? " Again, a nod. "Good. Just relax and rest. You're doing fine." He turned to the nurse. "Dr. Cole's due here any minute. Until he gets here, we'll just keep doing what we're doing."

The nurse looked at him queerly, then glanced over at the door. Zack followed her line of sight and found himself, once again, confronting the enigmatic ocean-green eyes. This time, though, the disconcerting woman behind them stepped forward and extended her hand. "Dr. Iverson, I'm Dr. Suzanne Cole, " she said simply. Her expression was totally professional, but there was an unmistakable playfulness in her eyes.

Zack felt the flush in his cheeks as he reached out and shook her hand.

"I'm sorry, " he mumbled. "It was sort of dumb for me to assume… what I mean is, you weren't exactly…"

"I know, " she said. Her tone suggested an apology for having allowed him to dig such a hole for himself. "I'm sure it was this outfit that confused you"-she indicated the blue scrubsuit-"but I just finished putting in a pacemaker." She nodded toward Annie, who was now fully awake and beginning to look around. "You seem to have done quite a job bringing this woman back, Dr. Iverson. Congratulations."

It was nearing midnight. Zack Iverson sat alone in the staff lounge at the back of the emergency ward, sipping tepid coffee, sorting through what had been, perhaps, the most remarkable June the thirtieth of them all, and trying to slow down his runaway fantasies concerning Suzanne Cole. It had taken several hours to ready a bed for Annie in the coronary care unit and to effect her transfer there. During that time, Zack had stayed in the background, watching Suzanne as she managed one dangerous cardiac arrhythmia after another in the woman, balancing complex treatments against their side effects, checking monitor readouts, reviewing lab results, then, suddenly, stopping to mop Annie's brow, or to smooth errant wisps of gray hair from her forehead, or simply to bend down and whisper encouragement in her ear. Unlike what Zack had imagined from her cool composure during their initial meeting, she was actually quite tense and frenetic during critical moments, moving from one side of the bed to the other then back, checking and rechecking to ensure that her orders were being carried out correctly.

Still, while she seemed frequently on edge, she was never out of control and it was clear that the nurses were comfortable with her ways, and even more important, trusted in them Who are you? his mind asked over and over as he watched her work. What are you doing up here in the boondocks?

The Judge and Cinnie had checked in twice by phone, and around ten, Frank had stopped by. He seemed restless and irritable, and although he mentioned nothing of the episode, Zack sensed that he was still quite upset by the Judge's outburst and thinly veiled threat.

Citing the need to be near the twins during the violent thunderstorm that had just erupted, he had left for home after only half an hour. But before he left, Zack had managed, in what he hoped was an offhanded way, to pump a bit of information from him regarding Suzanne Cole.

Dartmouth-trained and a member of the Ultramed-Davis staff for almost two years, she was thirty-three or thirty-four, divorced, and the mother of a six-year-old girl. In addition, she was co-owner, along with another divorcee in town, of a small art gallery and crafts shop Zack had tried, with little success, for a more subjective assessment of the woman, but Frank, distracted and anxious to leave, had completely missed the point. Now, as he sat alone, Zack wondered if it was worth waiting any longer for the woman to finish her work in the unit and, as she had promised, stop by for "a hit of decaf." The nurses had told him that it was not that uncommon for Suzanne, as they called her, to spend the night in the hospital if she had a particularly sick patient, and this night — with Annie and her pacemaker case-she had two Who are you? What are you doing up here?

The state of infatuation with a woman was not something with which Zack was all that familiar or comfortable. A bookworm throughout his college years, and a virgin until his junior year, he had had a reasonable number of dates, and a few short-lived romances after Lisette, but no prolonged relationships until Connie. He had once described his social life in college as a succession of calls to women the day after they had met someone special. Connie was five years younger than he, but possessed a worldliness and sophistication that he felt were missing from his life. She had an MBA degree from Northwestern, a management-track position at one of the big downtown companies, a condo in the Back Bay, a silver BMW, friends in the symphony, and an interest in impressionist painters ("Pissarro has more depth, more energy in one brush stroke, than Renoir has in a dozen canvases, don't you think? ") and foreign films ("Zachary, if you would stop insisting on plot all the time, and concentrate more on the universality of the characters and the technical brilliance of the director, this film would mean more to you"). Friends of his spoke to him from time to time of what they perceived might be a mismatch, but he countered by enumerating the new awareness Connie had brought into his life. Whether he truly loved the woman or not, he was never sure, but there was no questioning that he was, for most of their time together, absolutely infatuated with her beauty, her confidence, and her style. Her decision to break off their engagement had hurt him, but not as deeply as he first thought. And over the months that followed, he had spent what free time he had flying the radio-controlled airplane he had built in high school, exercising himself back into rock-climbing shape, hiking with Cheap dog, and horseback riding with friends along the seashore at the Cape-but not one minute at a gallery or locked in combat with a foreign film. "Hi."

Startled, Zack knocked over his Styrofoam cup, spilling what remained of his coffee into a small pool on the veneer tabletop. "Hi, yourself, " he said as Suzanne Cole plucked a pad of napkins from the nearby counter and dabbed up the spill. Was there to be no end to his ineptitude in front of this woman?

"It would seem you might have reached the limit of your caffeine quota for the day, " she said. She had changed into street clothes-gray slacks and a bulky fisherman-knit sweater-and she looked as fresh as if she had just started the day. "Actually, " he said. "I use caffeine to override my own inherent hyperness. I think it actually slows me down."

She smiled. "I know the syndrome. I'm surprised to find you still here, what with tomorrow being your first day in the office and all."

"I wanted to be sure Annie was out of the woods. She's been pretty special to me and my family. Besides, I just finished my residency yesterday. It'll probably be months before my internal chemistry demands anything more than a fifteen-minute nap in an institutional, Naugahyde easy chair."

"I remember those chairs well, " Suzanne said, leaning against the counter. "There's an old, ratty, maroon one in the cardiac fellows' room at Hitchcock that I suspect would one day have a sign on it proclaiming, Suzanne Cole slept here-and only here… So, it's a progress report you're after. Well, the news is good. At least for the moment. Your Annie's awake and stable, with no neurologic deficit that I can identify, although you might want to go over her in the morning. In fact, I think I'll make her your first consult, if that's okay. You did say you were going to do neurology as well as neurosurgery, yes?"

"Absolutely. I actually enjoy the puzzles nearly as much as I do the blood and guts."

Her eyes narrowed. "You sure don't talk like a surgeon, " she said. "The ones I know have signs in their rooms like, To cut is to cure, and All the world is pre-op."

"Oh, I have those, too. Believe me. Only as an enlightened, Renaissance surgeon, mine say, Almost all the world is pre-op." He pushed a chair from the table with his foot. "Here, have a seat."

"Sorry, but I can't, " she said. "I've got to go. Mrs. Doucette was my third critical admission this weekend, and I have a full day tomorrow.

You ought to get some sleep, too, so you'll be sharp for my consult.

Good night, now." She slipped on her coat and headed for the door.

"Wait, " Zack said, realizing even as he heard his own voice that the order was coming from somewhere outside his rational self-somewhere within his swirling fantasies. "Yes?"

She turned back to him. The darkness in her eyes and the set of her face were warning him not to push matters further. He picked up on the message too late. "I… um… I was wondering if we might have dinner or something together sometime."

Suzanne sagged visibly. "I'm sorry, " she said wearily. "Thank you, Zack's fantasies stopped swirling and began floating to earth like feathers. "Oh, " he said, feeling suddenly very self-conscious. "I didn't mean to… what I mean is, it seemed like-"

"Zack, I'm sorry for being so abrupt. It's late, and I'm bushed.

I appreciate your asking me, really I do. And I'm flattered. But I…

I just don't go out with people I work with. Besides, I'm involved with someone."

The last of the feathers touched down. Zack shrugged. "Well, then, " he said with forced cheer, "I guess I should just hope that a lot of folks show up at this hospital with combined cardiac and neurosurgical disease, shouldn't I?"

Suzanne reached out and shook his hand. "I'm looking forward to working with you, " she said. "I know we'll be terrific."

At that moment, from the far end of the emergency ward, a man began screaming, again and again, "No! I won't go! I'm going to die. I'm going to die!"

The two of them raced toward the commotion, which centered about an old man-in his seventies, Zack guessed-whom the nurse, the emergency physician, and a uniformed security guard were trying to move from a litter to a wheelchair. The man, with striking, long, silver hair and a gnarled full beard, was struggling to remain where he was. Zack's gaze took in his chino pants and flannel shirt, stained with grit, sweat, and grease, and a pair of tattered, oily work boots. The old man's left arm was bound tightly across his chest with a shoulder immobilizer, the tissues over his cheek and around his right eye were badly swollen by fresh bruises. "No! " he bellowed again. "Don't move me. I'm going to die if I go back there tonight. Please. Just one night."

"What gives? " Zack asked. The emergency physician, a rotund, former GP in town, named Wilton Marshfield, released his hold, and the old man sank back on the litter. "Oh, hi, Iverson, Dr. Cole, " he said, nodding.

"I thought you two had gone home."

"We were about to, " said Zack. "Everything okay?"

He had known Marshfield, a marginally competent graduate of a now-nonexistent medical school, for years, and had been surprised to find him working in the emergency room. During a conversation earlier in the evening, the man had explained that Frank had talked him out of retirement until a personnel problem in the E. R. could be stabilized.

"Plucked me off the scrap heap of medicine and offered me a salary as good as my best year in the office, " was how he had put it. "Sure, sure, everything's fine, " Marshfield said. "It's just that ol' Chris Gow here doesn't understand that Ultramed-Davis is a hospital, not a bloody hotel."

"What happened to him? " Suzanne asked. "Nothing as serious as it looks,

" Marshfield answered, with unconcealed disdain. "He just had a little too much of the hooch he brews up in that shack of his, and fell down his front steps. Fractured his upper arm near the shoulder, but there's not a damn thing we can do for that except ice and immobilization. Films of his facial bones are all negative, and so's the rest of his exam.

Now, we've got an ambulance all set to cart him home, but the old geezer won't let us take him off the litter without a fight. We'll take care of it, though. Don't worry."

Suzanne hesitated for a moment, as if she wanted to comment on the situation, but then nodded and backed off a step. Zack, however, brushed past the portly physician to the bedside. "Mr. Gow, I'm Dr. Iverson," he said. The old man looked up at him, but didn't speak. His face, beneath the beard and the filth, had an ageless, almost serene quality to it, but there was a sadness in his eyes that Zack had seen many times during his years of caring for the largely indigent Boston patients-a sadness born of loneliness and hopelessness. There was also no small measure of fear. "Are you in much pain?"

"Not according to him, I ain't, " the man answered, still breathing heavily from his struggles. "I wonder when the last time was he fell down the stairs like I did and broke his arm."

"Who do you live with?"

The old man laughed mirthlessly, wincing from the pain. Then he turned his head away. Zack looked to Marshfield for the answer. "He lives by himself in a shack at the endfof the old logging road off 219."

"Do you have a phone, Chris?"

Again, the man laughed. "How did you get here?"

"How do you think?"

"A trucker found him sitting by the highway and brought him in,"

Marshfield explained. "Chris is no stranger here. He's a woodcutter.

Periodically, he goes on a toot and cuts up himself instead of the wood." He laughed at his own humor and seemed not to notice that no one else joined in. "We sew him up and ship him back home until the next time."

Zack looked down at the old man. Could there be any sadder state than being sick or badly hurt, and being alone-of hoping, against hope, for someone to come and help, but knowing that no one would?

"Why can't he just be admitted for a day or two? " he asked. "Are there empty beds in the house?"

"Oh, we have beds, " Marshfield said, "but ol' Chris here doesn't have any kind of insurance, and unless his problem is life-threatening, which it isn't, he either goes to Clarion County, if we want to ship him out there, or he goes home."

"What if a staff doctor insists on admitting someone who can't pay?"

Marshfield shrugged. "It doesn't happen. If it did, I guess the physician would have to answer to the administration. Look, Iverson, you weren't around when this hospital admitted every Tom, Dick, and Harry who came down the pike, regardless of whether they could pay or not, but I'm here to tell you, it was one helluva mess. There were some weeks when the goddamn place couldn't even meet its payroll, let alone buy any new equipment."

"This man's staying, " Zack said. The emergency physician reddened. "I told you we had things under control, " he said. i, Zachan glanced down at the old man. Sending him home to an isolated shack with no phone and, as likely as not, no food, went against his evess instinct as a physician. "Under control or not, " he said evenly, "he's staying. Admit him to me as… malnutrition and syncope. I'll write orders."

Marshfield's jowly cheeks were now crimson. "It's your goddamn funeral,

" he said. "You're the one who's going to get called on the carpet by the administration."

"I think Frank will understand, " Zack said. This time, Marshfield laughed out loud. "There are a few docs beating the bushes out there for a job because they thought the same thing, Iverson."

"Like I said, he's being admitted."

"And like I said, it's your funeral. It's okay, Tommy, " he said to the guard. "You can go on about your rounds. Dr. Social Sewice, here is hell-bent on learning things the hard way."

He turned on his heels and stalked away. "Chris, you're going to stay, at least for the night, " Zack said, taking the old man's good hand in his. "I'll be back to check you over in a few minutes."

The man, bewildered by the sudden change in his fortune, could only stare up at him and nod. But the corners of his eyes were glistening.

Zack turned to Suzanne. "Come on, " he said, "I'll walk you outside. I can use the fresh air."

They walked through the electronically opened doorway and out onto the ambulance platform. A steady, windblown rain swept across the coal-black pavement. "I guess I have a few adjustments to make if I'm to sunive here," he said, shivering momentarily against the chill. Suzanne flipped the hood of her trench coat over her head. "Do us all a favor, " she said, "and don't make any ones you don't absolutely have to. That was a very kind thing you did in there."

"Insurance or not, that old guy's paid his dues."

"Perhaps, " Suzanne said. "Yes, perhaps he has. Well, I'll see you in the morning."

"Yeah."

She turned and took several steps, then turned back. "Zack, about that dinner. How about Wednesday night? My place."

Zack felt his pulse skip. "I thought you didn't date men you worked with?"

"No policy should be without exceptions, " she said. "You just made that point in there yourself, didn't you?"

"Yes. Yes, I suppose I did. But how about your… other involvement?"

She pushed her hood back from her forehead and smiled at him, first with her eyes, then with her lips. "I lied, " she said. IVERSON stood by the glass doors of her bedroom balcony, wincing as half a dozen spears of lightning crackled through the jet sky over the Androscoggin River Valley. Far below and to the south, Sterling incandesced eerily beneath the strobe. A cannonade of thunder rumbled, then exploded, shaking the tall, hillside A-frame like a toy. She tightened her robe and then tiptoed down the hall to check on the girls. Mercifully, after two fitful hours battling the ghosts of the storm, both were asleep. Lisette had never done well with thunderstorms herself, and felt no small guilt at having passed those fears on to her children. God, how she wished Frank would come to bed, or at least talk to her. It was nearly one in the morning, and he was still downstairs in "his" den, staring, she knew, at the embers in "his" fireplace, and listening over and over to the album of morose, progressive jazz he favored when he was angry at her. And as usual, she also knew, he would take his own sweet time in telling her why. It was the job, the hospital, that kept him so tense.

Lisette felt certain of it. For a year-no, much longer than that now, two at least-he had been a bear to live with. And with each passing week, each passing month, there seemed to be less and less she could do to please him. Silently, she cursed the day he had closed his business in Concord and moved back to Sterling, even if the little electronics firm was on the ropes. To be sure, his success with Ultramed had given them more than she could ever have imagined. But as she reflected on the dashing dreamer she had fallen in love with and married, Lisette told herself the price they were paying was far too high. For a time, she debated simply going to bed. If she did, of course, Frank would never come up. He would spend the night on the sofa in his den and would be in his office at the hospital by the time she and the twins awoke. With a sigh of resignation, she stepped into her slippers and headed down the stairs. There was no way she could outlast him. She cared, and he, for the moment at least, did not. The situation was as simple as that.