Flashback

CHAPTER FOUR

The Carter conference Room of Ultramed-Davis, refurbished by Ultramed but originally donated to the hospital by the paper company, was a large, all-purpose space, with deep-pile carpeting, a speaker's table and podium at one end, and seating for close to one hundred.

Metal-framed, full-color lithographs of significant moments in medical history lined the room on either side, and photographic portraits of past presidents of the medical staff filled the rear wall by the door.

Beneath each portrait was a small gold plaque engraved with the officer's name, year of birth and year of death. Beneath those photographs of past presidents still living, the date of birth had already been engraved, followed by a hyphen and a ghoulishly expectant space. It was seven-thirty in the morning of Wednesday, July 3. The medical staff usually met on the first Thursday of the month, but because of the holiday, the staff had voted to hold its July session on Wednesday instead. The heated debate on the subject, typical for any group of MDS, had taken up more than half of its June meeting. Forty physicians, nearly the whole staff of Ultramed-Davis, milled about the room, some exchanging pleasantries or bawdy stories, others obtaining "curbside consultations" from various specialists. A few merely stood by a window, staring wistfully at the brilliant summer day they would never have the opportunity to enjoy. Zack Iverson sat alone toward the back of the room, mentally trying to match the faces and demeanors of various doctors with their medical specialties (gray crew cut, red bow tie… pediatrician, forty-four long sportcoat, thirty-four-inch waist, slightly crooked nose… orthopedist), and musing on his first two days in practice. They had gone quite smoothly, with a number of consultations in the office and several in the hospital. He had even spent a brief stretch in the operating room, assisting one of the orthopedists in the removal of a large calcium deposit that had entrapped a young carpenter's right ulnar nerve at the elbow. Several times each day, he had visited with Annie, who was progressing reasonably well in the coronary unit. He had also discharged old Chris Gow after a day and a half of good nursing care and after arranging for social services to help him get medicare coverage, physical therapy, and one meal a day at home. Contrary to Wilton Marshfield's dire prediction, there had been no repercussions from Frank or anyone else regarding the old man's hospitalization. All in all, they had been two interesting and rewarding days-the sort that more than made up for medicine's liabilities as a career.

This day, however, was the one Zack had been awaiting. It would start with his first major case in the O. R. -the removal of a woman's ruptured cervical disc-and it would end with dinner at Suzanne's. He smiled to think of how misguided his apprehension about coming to Sterling had been. "Okay, everyone, find a seat."

The staff president, a pale, doughy internist named Donald Norman, called out the order as he hand-shook his way to the front of the room.

Norman had interviewed Zack twice on behalf of Ultramed, and it was actually in spite of the man and those two sessions that Zack had decided to come to Davis at all. A graduate of one of the medical schools in the Caribbean, Norman had been subsidized and trained at Ultramed hospitals and was a company man right down the line. His portion of the interviews had consisted of little more than a mirthless litany of Ultramed procedural and medical policies, each accompanied by a set of statistics justifying the "guideline" as beneficial to the welfare of both patient and hospital. While Norman hailed the streamlined corporate approach as "revolutionary and unquestionably necessary, " Zack wondered if it amounted to a sort of gentrification of health care. And he made no points whatever with the man by saying so.

To make matters worse between the two of them, Zack's spontaneity and relaxed, eclectic approach to medicine sat poorly with Norman, who, though no more than a year or two older than Zack, wore a threepiece suit, smoked a curved meerschaum, and generally conducted himself like some sort of aging medical padrone. In the end, with Zack's decision still very much in the air, several of — the other physicians on staff managed to convince him that Ultrameddavis was far more flexible in its policies and philosophy than Donald Norman liked to believe. Norman took his place at the front table and gaveled the meeting to order with the underside of an ashtray. During the secretary's, treasurer's, and committees' reports, several late-comers straggled in, including Suzanne, looking lithe and beguiling in sandals and a floral-print dress. She was accompanied by Jason Mainwaring, who, Zack noticed in spite of himself, wore no wedding ring, although he did sport a sizable diamond on one little finger. The two took seats on the opposite side of the room and continued a whispered conversation, during which the charismatic general surgeon touched her on the arm or hand at least half a dozen times. Zack spent a minute or two trying, unsuccessfully, to catch her eye, and then gave up and turned his attention to the meeting.

"Any additions or corrections to the committee reports? " Norman was saying. "If not, they stand accepted as read. Old business?

" One hand went up, accompanied by low groans from several parts of the room. "Yes, Dr. Beaulieu, " Norman said, taking no pains to mask the annoyance in his voice. From his seat, five or six rows in front of Zack, Guy Beaulieu stood, looked deliberately about the room, and finally marched up to the speaker's podium-a move that prompted several more groans. Zack, who had not seen Beaulieu in three or four years, was struck by the physical change in the man. Once energetic and robust, he was now almost pathologically thin. His suit was ill-fitting and his gaunt face had a sallow, grayish cast. Still, he held himself rigidly erect, as had always been his manner, and even at a distance, Zack could see the defiant spark behind his gold-rimmed bifocals. "Thank you, Mr.

President, " Beaulieu began, with a formality that probably would have sounded unnatural and patronizing coming from most in the room, but coming from him, did not. His speech still bore an unmistakable French-Canadian flavor, especially his "th" diphthongs, which sounded more like d's. "I know that many of you are becoming a bit weary with my monthly statements on behalf of those who are not being cared for by this institution, as well as against those of you who have slandered my name in this community. Well, I promise you that this will be the last in that series. So, if you will just bear with me…"

He removed a couple of sheets of yellow legal paper from his suitcoat pocket and spread them out on the podium. Once again, there were muted groans from several spots in the room. Zack glanced over at Jason Mainwaring, who now sat motionless, staring impassively at the man. At that moment Suzanne turned and caught his eye. Zack waved a subtle greeting with three fingers, and she nodded in return. She seemed, even at a distance, to be preoccupied. "I would like to inform the medical staff of Ultramed-Davis Hospital, " Beaulieu read, adjusting his bifocals, "that I have retained the Concord firm of Nordstrom and Perry, and have filed a class-action suit against this hospital, its administration, its medical staff, and the Ultramed Hospitals Corporation on behalf of the poor and uninsured people in the Ultramed-Davis treatment area. I am being joined in this effort by a number of present and former patients who fall into that group, including Mr. Jean Lemoux, Mr. Ivan Macgregor, and the family of Mme.

Yvette Coulombe. "The charges, which include unlawful and callous discharge from the hospital, improper patient transfer, and refusal to treat, are currently under review by Legal Assistance of New Hampshire, who have promised a decision in the next two weeks as to whether or not they will join our effort. As I have said many times before, sound, compassionate medical care is a right of all people, not a privilege.

The attitude of this facility has, over the past three years, become one of, Why should you get health care just because you are sick? We intend to fight that policy."

Zack glanced around the room and catalogued myriad reactions among the physicians, few, if any of them, seemed sympathetic, and none of them appeared very threatened or upset. Some were openly exchanging looks and gestures of disgust, and one was actually circling a finger about one ear. There are a few docs out there beating the bushes for a job because they thought the same thing, Iverson. Wilton Marshfield's warning against bucking the Ultramed system echoed in Zack's thoughts as he studied the sea of blank and disapproving expressions. Suzanne's, he noted, fell vaguely in the second group. Beaulieu, too, paused and looked about, but then he continued as if unperturbed. "In addition to the charges outlined above, we shall document a progressive and unethical blurring of the distinction between medical suppliers and providers, to the point where the care of patients throughout and without this facility is being compromised. We have evidence to back up our position, and every day we acquire more. It is my hope that those on the medical staff who have information which will further substantiate our claims will come forward and present such information to me or to our attorney, Mr. Everett Perry. I assure you that all such disclosures will be kept in the strictest confidence."

The man, for all of his "crustiness, " as the Judge had put it, had guts, Zack acknowledged. Again he scanned the room, guts, yes, but not a speck of visible support. "Finally, " Beaulieu read on, "I would like to announce that I, personally, have initiated legal action against a member of this staff, as well — as against the administration of this hospital, who are, I believe, responsible for the slanderous, inaccurate, and highly damaging rumors regarding my personal and professional conduct. I call upon any physician who has knowledge of this matter to come forward. Again, I promise strictest confidence.

Remember, there but for the grace of almighty God go any one of you. "I thank you for your patience, and would welcome your questions and comments."

Not a hand was raised. Beaulieu nodded in a calm and dignified manner, and then returned to his seat, apparently unmindful of the many annoyed and angry expressions that were fixed on him. The staff meeting proceeded uneventfully. At the end of "new business, " Zack was formally introduced and welcomed with brief, measured applause. Sensing that some verbal acknowledgment of the greeting was called for, he stood up.

"Thank you all very much, " he began. "It feels great to be home again, and to be on the medical staff of the hospital in which I was born. As Dr. Norman noted in introducing me, in addition to my neurosurgical practice, I shall try to function as a medical neurologist until we are large enough, and lucky enough, to get one of our own. It is my hope to care for all those who need help in my area of expertise"-he glanced over at Guy Beaulieu-"regardless of their ability to pay. "I would also like to thank our radiologists, Drs. Moore and Tucker, as well as my brother Frank, for their work in obtaining our CT scanner. It's a beautiful piece of equipment, and both radiologists have gone out of their way to become versed in its use. Sometime soon, the three of us plan to present some sort of workshop on the interpretation and limitations of the technique. "Since my nearest backup is close to a hundred miles away, I'll be on twenty-four-hour call, except during my vacation, which is scheduled from August third through August fifth… three years from now. Thank you."

There was laughter and applause from around the room. "Oh, one more thing, " Zack added as the reaction died away. "I expected there might be some unusual problems arising from my decision to return and set up shop in the town where I was born and raised. So I'd like to make it perfectly clear that there is absolutely no truth to the rumor-started, I believe, by Dr. Blunt over there, who delivered me and was my pediatrician-that I won't go into the operating room without the one-eyed teddy bear I insisted on clinging to during his examinations."

Suzanne, with Jason Mainwaring in tow, caught up with Zack in the corridor. "Zack, hi, " she said. "Thanks for the laughs in there. Have you met Jason?"

"I think briefly, a few months ago, " Zack said, shaking the surgeon's hand. "Nice to see you again."

"Same here, " Mainwaring said, in a pronounced drawl. "That was a cute little speech, Iverson. I was especially partial to the line about the teddy bear."

"Thanks, " Zack said, wondering if the man was being facetious. "I even liked that other one. About your next vacation being so far away. You're a funny man."

"Thanks again."

"However, " the surgeon continued, "I would caution you against makin' any more inflammatory statements about this Beaulieu business until you know all the facts. Y'see, Iverson, I'm the staff member Beaulieu alluded to in there-the one he's suin'. And noble as you tried to sound in your little pronouncement there, you and Beaulieu aren't the only ones who do charity work. I operate on plenty of folks who can't pay, too. Zack was startled by the man's rudeness. "Well, " he said, "I'm glad to hear that. I only hope they get their money's worth."

"You know, " Mainwaring countered, "I've always heard that only the most arrogant and sadistic surgeons elect to spend their professional lives suckin' on brain…"

"Hey, guys, what is this? " Suzanne cut in. "This sounds like the sort of exchange you both should have put behind you when you climbed down from your tree houses and started high school. Jason, what's with you?

Were you attacked in your crib by a mad neurosurgeon or something?"

Mainwaring smiled stiffly. "My apologies, Iverson, " he said. He extended his hand, but shielded from Suzanne the hostility in.. his eyes was lcy. "Hey, no big deal, Jason. No big deal."

"Good. Well then, we'll have to see what we can do about drummin' up a little neurosurgical business for y'all."

"Thanks."

"Meanwhile, you might try to steer clear of politics around this place-at least until you've been here long enough to learn everyone's name." He checked his gold Rolex. "Suzanne, dear, I believe we still have time to complete our business. Nice to see you, Iverson. I'm sure you'll make the adjustment to this sleepy little place just fine."

Without waiting for a response, he took Suzanne's arm and strode down the hallway. Andy O'Meara, red-cheeked, beer-bellied, and beaming, strolled among the tables of Gillie's Mountainside Tavern, shaking hands and exchanging slaps on the back with the twenty or so men enjoying their midday break in the smoky warmth. Over nearly twenty years he had come to know each and every one of them well, and was proud to call them his friends. "Andy O, you old fart. Welcome back! "… "Hey, it's Mighty Mick. Way to go, Andy. Way to go. We knew you'd beat it."

First the cards and candy and flowers when he was in the hospital, and now this welcome back. They were a hell of a bunch. The very best. And at that moment, as far as Andy O'Meara was concerned, he was the luckiest man alive. Tomorrow would be Independence Day-the day for celebrating the birth of freedom. And this day was one for celebrating his own rebirth. "Hey, Gillie, " he called out, the lilt of a childhood in Kilkenny still coloring his speech. "Suds around, on me."

After three months of pain and worry, after more than a dozen trips to Manchester for radiation therapy, after sitting time and again in the doctor's office, waiting for the other shoe to fall, waiting for-the news that "We can't get it all, " he was back on the road, cured. The bowel cancer that had threatened his very existence was in some jar in the pathology department at Ultramed-Davis Hospital, and whatever evil cells had remained in his body had been burnt to hell by the amazing X-ray machines. The backseat and trunk of his green Chevy were once again filled with the boxes of shoes and boots and sneakers that he loved to lay out for the merchants along route 16, and the rhythm of his life had at last been restored. "To the luck of the Irish, " he proclaimed as he hoisted the frosted mug over his head. "And to you, Andy O, " Gillie responded. "We're glad to have you back among the living."

Andy O'Meara exchanged handshakes and hugs with each man in the place, and then set his half-filled tankard on the bar. It was his first frosty in more than twelve weeks, and with a full afternoon of calls ahead of him, there was no sense in putting his tolerance for the stuff to the test. He settled up with Gillie and stepped out of the dim, pine-paneled tavern, into the sparkling afternoon sunlight. He prided himself on never being late for a call, and Colson's Factory Outlet was nearly a thirty-minute drive through the mountains. He switched on the radio.

Kenny Rogers was admonishing him to know when to hold and know when to fold. The country/western music, usually Andy's staple, seemed somehow out of keeping with the peace and serenity of this day. At the edge of the driveway he stopped and changed to a classical program on WEVO, the public station. Better, he thought. Much better. The tune was familiar.

Almost instantly, it conjured up images in Andy's mind-softly falling snow… a stone hearth… a roaring fire… family. As he hummed along, Andy tried to remember where he had heard the haunting melody before."… What child is thi-is, who laid to re-est in Mary's la-ap, lay slee-eeping?…"

He surprised himself by knowing many of the words. "This, thi-is is Christ the Ki-ing, whom shepherds gua-and and angels sing…"

It was the Christmas carol, he suddenly realized. That was it. As a i child in Ireland it had been one of his favorites. How strange to hear it in the middle of summer. He paused to let a semi roar past. The noise of the truck was muted — almost as if it made no sound at all. Andy shrugged. As wonderful as it felt to be back on the road again, it also felt a little odd."… Haste, ha-aste to bring him lau-all-aud, the Ba-abe, the so-on of Mary…"

He closed the windows, turned on the air conditioner, and swung out of the drive onto route 110. The green of the mountainside seemed uncomfortably bright. He squinted, then rubbed at his eyes and wondered if perhaps he should stop someplace to pick up a pair of sunglasses. No, he decided. No stops. At least not until after Colson's. Settle down, old boy, he said to himself. Just settle down. He adjusted the signal on the radio and settled back in his seat, humming once again. Route 110 was two lanes wide, with a narrow breakdown space on either side. It twisted and turned, rose and dropped like an amusement park ride, from Groveton on the Vermont border, along the ridge of the Ammonoosuc River Valley, to Sterling and Route 16. A scarred, low, white guardrail paralleled the road to Andy's right, and beyond the rail was the gorge, at places seven hundred feet deep. Andy's restless, ill-at-ease sensation was intensifying, and he knew he was having difficulty concentrating. He adjusted his seatback and checked his safety harness.

The guardrail had become something of a blur, and the solid center line kept working its way beneath his left front tire. He tightened his grip on the wheel and checked the speedometer. Forty-five. Why did it feel like he was speeding?

Subtly, he noticed, the trees on the mountainside had begun to darken-to develop a reddish tone. He rubbed at his eyes and, once again, forced the sedan back to the right-hand lane. Twenty-five years on the road without an accident. He was damned if he was going to have one now. Ahead of him, the scenery dimmed. A tractor trailor approached, sunlight sparking brilliantly off its windshield. Suddenly, Andy was aware of a voice echoing in his mind-a deep, slow, resonant, reassuring voice, at first too soft to understand, then louder… and louder still. "Okay, Andy, " it said, "now all I want you to do is count back from one hundred… count back from one hundred… count back from one hundred…"

Out loud, Andy began to count. "One hundred… ninety-nine… ninety-eight…"

A blue drape drifted above him, then floated down over his abdomen.

"Ninety-seven… ninety-six…" e Hands, covered by rubber gloves, appeared in the space where the drape had been. "Ninety-five… ninety-four… Why aren't I asleep?" his mind asked. "Ninety-three… ninety-two."

"Bove electrode, please, " the low voice said. "Set it for cut and cauterize."

Another pair of gloved hands appeared, one of them holding a gauze sponge, and the other, a small rod with a metal tip. Slowly, they lowered the metal tip toward his belly. "Ninety-one… ninety-"

Suddenly, a loud humming filled his mind. The metal tip of the rod touched his skin just below his navel, sending a searing, electric pain through to his back and down his legs. "Jesus Christ, stop! " Andy screamed. "I'm not asleep! I'm not asleep!"

The wall of his lower abdomen parted beneath the electric blade, exposing a bright yellow layer of fat. "Eighty-nine!.. Eighty-eight! … For God's sake, stop! It's not working! I'm awake! I can feel that!

I can feel everything! "

"Metzenbaums and pick-ups, please."

"No! Please, no!"

The Metzenbaum scissors sheared across Andy's peritoneum, parting the shiny membrane like tissue paper and exposing the glistening pink rolls of his bowel. Again, he screamed. But this time, the sound came from his voice, as well as from within his mind. His vision cleared at the moment the right headlight of his automobile made contact with the guardrail.

The Chevy, now traveling at nearly ninety miles an hour, tore through the protective steel as if it were cardboard, crossed a narrow stretch of grass and gravel, and then hurtled over the edge of the gorge.

Strapped to his seat, Andy O'Meara watched the emerald trees flash past.

In the fourth second of his fall, he realized what was happening. In the fifth, the Chevy shattered on the jagged rocks below and exploded. ill THE CAFETERIA OF Ultramed-Davis, like most of the facility, had been renovated in an airy and modern, though quite predictable, style. The interior featured a large, well-provisioned salad bar, and a wall of sliding glass doors opened onto a neat flagstone terrace with a half-dozen cement tables and benches. Pleasantly exhausted from his three-hour cervical disc case, Zack sat at the only table partially shaded by an overhanging tree and watched as Guy Beaulieu maneuvered toward him through the lunchtime crowd. During the summer Zack had spent as an extern at the then Davis Regional Hospital, Beaulieu had been extremely busy with his practice and with his duties as president of the medical staff. Still, the man always seemed to have enough time to stop and teach, or to reassure a frightened patient, or to console a bereaved family. And from that summer on, the surgeon's blend of skill and compassion had remained something of a role model for Zack. "So,"

Beaulieu said as he set down his tray and slid onto the stone bench opposite Zack, "thank you for agreeing to dine with me."

"Nonsense, " Zack replied. "I've been looking forward to seeing you ever since I got back to town. How is your wife doing? And Marie? "

"Clothilde, bless her heart, is as good as can be expected, considering the filthy stories she has had to contend with these past two years. And as for Marie, as you may have heard, she grew weary waiting for you to propose and went ahead and married a writer-a poet of all things-from Quebec."

Zack smiled. He and Marie Beaulieu had been friends from their earliest days in grammar school, but had never been sweethearts in any sense of the word. "Knowing Marie, I'm sure he's very special," he said. "You are correct. If she could not have you, then this man, Luc, is one I would have chosen for her. In an age when most young people seem to care for nothing but themselves, he is quite unique-consumed by the need to make a difference. He works for a village newss'der and crusades against all manner of social injustice while he waits for the world to discover his poems."

"Kids?"

"They have two children, and I don't know how on earth they manage to feed them. But manage they do."

"And they're happy, " Zack said. "Yes. Poor and crusading, but happy, and as in love-more so, perhaps-than on the day they were married."

Zack held his hands apart. "C'est tout ce que conte, n'est ce pas?"

Beaulieu's smile was bittersweet. "Yes, " he said. "That is all that matters." He paused a beat for transition. "So, your old friend Guy Beaulieu is a little short of allies in this place."

"So it sounds, " Zack said, picking absently at his salad. Beaulieu leaned forward, his eyes and his voice conspiratorial. "There is much going on here that is not right, Zachary, " he whispered. "Some of what is happening is simply wrong. Some of it is evil."

Zack glanced about at the newly constructed west wing, at the helipad, at the clusters of nurses and doctors enjoying their noontime breaks on the terrace and inside the cafeteria. "You'll understand, I hope, if I say that I see little evidence of that around me. Could you be more specific?"

"Your father spoke to you, yes?"

"Briefly."

"So you know about the lies."

"I know something of the rumors, if that's what you mean."

Beaulieu leaned even closer. "Zachary, I beg your confidence in this matter."

"That goes without asking, " Zack said. "But I have to warn you of something. The Judge on Sunday, and you again this morning, suggested that at least some of your quarrel might be with Frank. You should know that I have absolutely no desire to take sides in that disagreement.

Your friendship means a great deal to me. I don't know if I'd even be a surgeon today if it weren't for your influence. But Frank's my brother.

I can't imagine lining up against him."

"Even if he was in the wrong?"

"In my experience, Guy, right and wrong are far more often shades of gray than black and white. Besides, I tried my hand at crusading during my years at Boston Muni. All it got me was a tension headache the size of Alaska. I should have bought stock in Tylenol before I took my first complaint to the Muni administration. I'll listen if you want to talk, but please don't expect anything."

"Thank you for the warning, " Beaulieu said. "Even though I have a great fondness and respect for you, and even though, as you no doubt gathered, I haven't much support around this place, I was reluctant to share with you what I know, largely because of Frank. But then, when you said what you did at the meeting this morning-I mean about treating anyone, regardless of their ability to pay-well, I sort of took that as an invitation to talk." Zack sighed. "You thought correctly, " he said finally. "I fight it tooth and nail, but when I'm not looking, the part of me that can't stand seeing people get screwed always seems to sneak to the surface."

"Yes, I heard what you did for that old woodcutter the other night."

"You did?"

"Don't be so surprised. This hospital, this entire town, in fact, has a communication system that would make the Department of Defense green with envy. You had best accept that fact and adjust to it if you're going to survive here. Drop a pebble in the lake and everyone-but everyone-will feel the ripple. That's why stories, such as those that have been spread about me, are so damning. In no time at all, everyone has heard a version."

"Like that old game-telephone."

"Pardon?"

"It's a party game we used to play. Every one sits in a circle, and the first person whispers a secret to the one next to him. Then the secret goes all around the circle, and by the time it gets back to the one who started it, it has totally changed. It bothers me terribly to think that anyone would deliberately be doing anything to hurt you, especially making the sort of accusations the Judge says have been flying around."

"They are lies, you know, Zachary. Every last one of them."

Zack studied the Frenchman's face-the set of his jaw, the dark sadness engulfing his eyes. "I know, old friend, " he said at last. "I know they are."

"So…" Beaulieu tapped his fingertips together, deciding where to begin. "What did you think of my little prepared statement this morning?

" he asked finally. "Well, the truth is, I thought you handled yourself, and expressed yourself, very well."

Beaulieu smiled. "Diplomatically put, my boy. But please, continue, and remember, my feelings are quite beyond being hurt."

Zack shrugged. "Okay, if you really want to know the truth, I kept thinking that all that was missing from the whole scenario was a horse, a lance, a shaving-bowl helment, and Sancho Panza."

This time, the older surgeon laughed out loud "So, you think I am tilting at a windmill, is that it? Well, my young friend, let me give you a closer look at that windmill. Richard noulombe. Do you know him?"

"The pharmacist? Of course I know him. I called in a prescription him just yesterday."

"And did you know that he does not own his pharmacy anymore?"

"The sign says Coulombe Drug."

"I know what the sign says. I also know that Richard is now an employee, and not a proprietor. He sold his store nearly two years ago to a chain outfit named Eagle Pharmaceuticals and Surgical Supplies. I do not know how that particular deal, with that particular company, was brought about, but I can guess now that it was no accident. Richard did not want to sell, but he needed the money to pay an enormous debt-a hospital bill and a surgeon's bill, Zachary-run up by his wife, now his late wife, Yvette, during a series of cancer operations."

Beaulieu chewed on a bite of sandwich as he gauged Zack's reaction.

"Did you perform the operations? " Zack asked. The surgeon shook his head. "The Coulombes had been my patients for many years, but shortly before Yvette began having symptoms, the rumors about me began circulating. Like most of the other people in town, they decided, or were told-I'm still not exactly certain which-to go and see Jason Mainwaring, instead. They were also told that their insurance coverage was quite limited, but that barring complications, most of Yvette's bills would be covered."

"But complications there were."

"Four separate operations, all of them indicated and due to unforeseeable circumstances, as far as I can tell, but four nonetheless.

Then there was a protracted stay in the Sterling Nursing Home. In fact, Yvette never did return home before she died."

"And, of course, there were more bills for that. I get the picture."

"Actually, " Beaulieu said gravely, "you haven't gotten the picture at all… yet. You see, Ultramed Corporation not only owns our hospital, it now owns both nursing homes in town as well. Did you know that?"

"No, " Zack said. "No, I didn't."

"The corporate name is the Leeward Company. They own nursing homes and rehabilitation centers all over the east and midwest, and about three years ago they purchased the two here in Sterling. But what not so many people know, including me until just a few months ago, is that Leeward is a division of Ultramed, bought out by them precisely four years ago.

The bills for all three institutions-Ultramed-Davis and the two nursing homes-are actually spit out of the same computer. I'm not going to tell you who's in charge of that computer, but you can guess if you wish."

"I don't have to, " Zack said, wondering why Frank had never mentioned the purchase of the nursing homes to him. "Coulombe's story is a very sad one, especially with the unfortunate outcome for his wife. But I see nothing evil or even immoral in it."

"That is because you are missing a piece of the puzzle, " Beaulieu said.

"A crucial piece. And remember, " he added, "what I am about to reveal to you is just the tip of the iceberg."

"Go on, " Zack said, wishing now that the man would not. Beaulieu pulled a folded typed sheet from his jacket pocket, smoothed it out on the table, and slid it across to Zack. "As I mentioned before, " he said, "I do not have too many allies in my little crusade. But I do have some.

One of them has spent nearly six months traveling from place to place, trying to gather information for me. Just last week he came up with this. It's a list of the boards of directors of two companies."

Zack scanned the parallel lists of names, headed simply R and EPSS. Five of the ten names on each list were identical. "What do these letters stand for? " he asked. The fire in Guy Beaulieu's eyes intensified. "The R stands for RIATA of Boston, the megaglomerate that owns Ultramed. In a sense, they are our bosses, Zachary. Yours, mine, and every other doctor's in town."

"And the other?"

"The other, my friend, stands for Eagle Pharmaceuticals and Surgical Supplies-the corporation that bought out Richard Coulombe. Their boards of directors interlock."

Beaulieu illustrated his point by sliding the fingers of one hand between the fingers of the other. Before he could respond, Zack saw movement at the corner of his eye. He slid the paper onto his lap at the instant a shadow fell across the table. He and Beaulieu looked up.

Frank, smiling benignly, stood not five feet away from them, holding a tray of food. "Are you gentlemen having a heart-to-heart? " he asked.

"Or do you have room at the table for one more?"

Carefully, Zack folded the sheet of paper and slid it into his pocket, although he sensed the move was a fruitless one. Frank had heard at least part of their conversation. Of that, he was almost certain.

A Bach fugue was playing on the small cassette deck by the sink. Barbara Nelms, staring glumly at the bathroom mirror, ran a finger over the furrows in her forehead and the crow's feet at the corners of her eyes.

The creases had, it seemed, appeared overnight. Instinctively, she reached for her makeup kit. Then, just as quickly, she snapped off the tape, turned and walked from the bathroom. If she was bone-tired, if she was stressed close to the breaking point, if frustration and fear had aged her six years in six months, why in the hell should she try to hide it anymore?

The product of a perfectly uncomplicated unbringing in Dayton, Ohio, and four idyllic years as a business and marketing major at tiny St. Mary's College in Missouri, she had always prided herself on being a model parent, wife, citizen, and member of society. She was a registered Democrat, a voting Republican, an officer in the PTO three years running, a scout leader, a reader at church, a better than average pianist and tennis player, and, at least according to her husband, the best lover a man could ever want. But now, after six months of haggard guidance counselors and harried school resource workers, of evasive, pompous behavioral psychologists and bewildered pediatricians, none of that mattered.

She had dropped off all committees, hadn't picked up a tennis racket in weeks, and couldn't remember the last time she and Jim had had sex.

Something was wrong, terribly wrong, with her son. And not only could none of the so-called specialists they had seen diagnose the boy's problem, but each seemed bound and determined to convince her that it fell in someone else's bailiwick. The violent episodes, occurring at first monthly, but now almost once a week, had enveloped Toby in a pall of melancholy and fear so dense that he no longer smiled or played or even spoke, except for occasional monosyllables in answer to direct questions-and then only at home. Situational depression, delayed autism, childhood schizophrenia, developmental arrest with paranoid ideation, acting out for secondary gain, the labels and explanations for Toby's condition were as varied-and as unacceptable-as the educators and clinical specialists who had applied them. The boy was sick, and he was getting sicker. He had lost nearly ten pounds from a frame that had not an ounce of fat to begin with. He had stopped growing. He had failed to satisfy the requirements for promotion to the fourth grade. He avoided interacting with other children. He had been given vitamins, antidepressants, Thorazine, Ritalin, special diets. She had taken him to Concord, and then to Boston, where he had been hospitalized for four days. Nothing. Not a single objective clue. If anything, he had returned from the medical mecca even more uncommunicative than before. Now, as she prepared to drag her son to yet another specialist-this one a young psychiatrist, new in town, named Brookings-Barbara Nelms felt the icy, all-too-familiar fingers of hopelessness begin to take hold. Toby's episodes at first seemed like horrible nightmares. Several times she had actually witnessed them happen-watched helplessly as her son's eyes widened and grew glassy, as he withdrew into a corner, drifting into a terrifying world he would share with no one. She had listened to his cries and had tried to hold him, to comfort him, only to be battered about the head and face by his fists. In the end, there was nothing she could do but stay close, try her best to see that he didn't hurt himself, and wait. Sometimes the episodes would last only half an hour, sometimes much longer than that. ' 518 Always they would end with her son mute, cowering, and totally drained. Perhaps this will be the day, she said to herself. Perhaps this man, Brookings, the first full-time psychiatrist in the valley, would have the answer. But even as she focused on this optimistic thought, even as she buttoned her blouse and smoothed the wrinkles she should have ironed from her skirt, even as she went to her son's room to fetch him for yet another evaluation at yet another specialist's office, Barbara Nelms knew that nothing would come of it. Nothing, perhaps, except another label. And time, she also knew, was running out. The drive from their house to the Ultramed-Davis Physicians and Surgeons Clinic took fifteen minutes. For most of the ride, Barbara Nelms kept up a determined conversation with her son-a conversation that was essentially a monologue. "This doctor's name is Brookings, Toby. He's new in town, and he specializes in helping people with attacks like yours… We're going to get to the bottom of this, honey. We're going to find out what's wrong, and we're going to fix it.

Do you understand?"

Toby sat placidly, hands folded in his lap, and stared out the window.

"It would make it easier for Dr. Brookings to do his job if you would talk to him-tell him what it is you see and feel when you have the attacks. Do you think you can try and do that?… Toby, please, answer me. Will you try and talk to Dr. Brookings?"

Almost imperceptibly, the boy nodded. "That's good, honey. That's wonderful. We all just want to help.

No one's going to hurt you."

Barbara Nelms thought she saw her son shudder at those words. She swung her station wagon into one of the few spaces left in the crowded parking lot, locked her door, and then walked around the car to let Toby out. It was a promising sign that he had unbuckled his safety belt himself.

Instantly, hope resurfaced. Perhaps this would be the day. The only other time she and Toby had been in the Ultramed-Davis Physicians and Surgeons Clinic was for a brief follow-up visit with Dr. Mainwaring.

Toby's pediatrician worked out of an old Victorian house on the north side of Sterling. A directory, framed by two large ficus trees in the gleaming, tiled lobby, listed two dozen or so doctors, along with their specialties. Phillip R. Brookings, MD, Child and Adult Psychiatry was on the second of the three floors. "Toby, do you want to take the stairs or the elevator?… Honey, I promise you, Dr. Brookings just wants to talk. Now, which will it be?… Okay, we'll take the stairs, then."

Barbara took his hand and led him up the stairs, half wishing he would react, make some attempt to pull away. He was plastic, emotionless.

Still, she could tell he was completely aware of what they were doing. A small plaque by the door to room 202 read P. R. BROOKINGS, MD, RING BELL ONCE AND ENTER. The waiting room was small and windowless, with textured wallpaper, an array of black-and-white photographs of mountain scenes, and seating for only four. At one side was a small children's play area, consisting primarily of dog-eared Highlights magazines, multicolored building blocks, and puzzles, none of which, Barbara knew, Toby would be interested in. She ached at the image of her son before it all began, huddled on the floor with his father, pouring excitedly over his Erector Set. No, Daddy, this way… turn it this way… See?

At precisely three o'clock, Phillip Brookings emerged from the inner office, introduced himself stiffly to her with a handshake and to Toby with a nod. He looked even younger than she had anticipated-no more than thirty-two or — three, she guessed, although his thick moustache made it hard to tell. As so often had happened over the preceding months, Barbara found herself wondering if she had aged so much, or if doctors were actually getting younger. "So, " he said, taking one of the two remaining empty chairs, "welcome to my office. Toby, I appreciate your coming to see me, and I hope we can help you to feel better."

He wore a button-down shirt and tie, but no jacket, and Barbara's initial impression, despite his youth, was positive. If nothing else, he had started off on the right foot by not talking down to the boy. She glanced over at Toby, who sat gazing impassively at the photos on the wall. "Here's the medical history form you sent us, Dr. Brookings," she said, passing the paper over. "You have the other reports I sent you?"

Brookings nodded and briefly scanned the sheet. "I think, " he said,

"that if it is all right with Toby, I would like to speak with him alone in my office. What do you say, Toby?… We can keep the door open if you want, okay?"

He stood up and stepped back to the doorway of his inner office. "Are you coming?"

"Go ahead, honey, " Barbara urged. "I'll be right here. Remember what I said. There's nothing to be afraid of."

Slowly, Toby rose from his chair. "Wonderful, " Brookings said. "Come in. Come in."

Silently, but with every fiber, Barbara Nelms cheered her son on.

He was being more cooperative, more open to this man than he had been to anyone she had taken him to in some time. Perhaps, at last, he was ready. Perhaps… She watched as Brookings disappeared into his office.

From where she sat, directly opposite the doorway, she could see a roomy, comfortably furnished office with a large picture window, and plants arranged on the floor and hanging from the ceiling. Go on, darling Go ahead in. It's okay. It's okay. After a brief hesitation, Toby followed Brookings in. Then, after a single, tentative step inside the door, he stopped, his gaze riveted on the broad picture window across from him. "Come in, Toby, " Barbara heard Brookings say. "I'm not going to hurt you."

Barbara could see Toby's body stiffen. His hands, which had been hanging lifeless at his side, began to twitch. Dear God, she thought, he's going to have an attack. Right here.

Right now. "Toby, are you all right? " Brookings asked. Toby took several backward steps into the waiting room, his face chalk white, his eyes still fixed on the window. "Honey, what's wrong? " Barbara felt her muscles tense. No one but she and her husband had ever witnessed one of the attacks before. Frightened as she was, she sensed a part of her was actually grateful for what was about to happen. At least someone else would know what they had been going through all these months.

Instinctively, she glanced about for any objects on which Toby might hurt himself. Then, suddenly, the boy turned, threw open the outer office door, and raced out into the hall. "Toby! " Barbara and Brookings, who had come out of his office, called out in unison. The psychiatrist was across the waiting room and out the door before she had left her seat. Barbara reached the corridor just as he disappeared through the stairway door. Her pumps were almost impossible to run in.

At the head of the stairs she kicked them off and skidded down to the first floor, falling the last three steps and skinning her shin. As she limped into the lobby, Barbara heard the horrible screech of an automobile's tires and froze, anticipating the sickening thump of the car hitting her son. There was none. Instead, through the glass doorway, she saw him weaving through the parking lot, running as she had not seen him do in many months. Phillip Brookings was a dozen yards behind and closing. Barbara raced across the drive, narrowly avoiding being hit by a car herself. "Toby, stop! Please stop!"

The boy had made it beyond the parking lot and was sprinting across a stretch of thirty-or-so yards of lawn, toward the dense woods beyond.

Brookings was now no more than a few steps behind him. With only a yard or two to go before the forest, the psychiatrist launched himself in a flying tackle, catching Toby at the waist and hauling him down heavily.

"Thank God, " Barbara panted, hurrying across the parking lot. This was the first time, in all of his attacks, that Toby had done anything like this. Even at a distance she could tell that, although he was pinned beneath the physician, Toby was struggling. As she neared she could see his efforts lessen. "Toby, stop that, " she heard Brookings saying firmly, but gently. "Stop fighting me and I'll let go."

Barbara approached cautiously, expecting to see the familiar lost, glassy terror in her son's eyes. What she saw, instead, was a fierce, hot mix of anger and fear. It was almost as if he were snarling at the man. Carefully, Brookings pushed himself away, although he still maintained a grip on the boy's belt. As Barbara knelt beside her son, she realized that this was not one of his attacks after all-at least not a typical one. He was awake and alert. Whatever had set him off was in this world, not in the world locked within his mind. "Toby, are you all right? " she asked. "What happened? What frightened you so?"

The boy did not answer. "I'm going to let you go, Toby, " Brookings said. "Promise me you won't run?"

Again, there was no response. Slowly, Brookings released his grip on Toby's belt. The boy, still breathing heavily, did not move. "What was it? " Barbara asked. "Pardon? " Brookings's shirt and the knees of his tan trousers were stained with grass, and he, too, had not yet caught his breath. "Dr. Brookings, Toby saw something out your window-something that frightened him. This wasn't one of his attacks."

She turned to her son. "It wasn't, was it, honey?"

Tears glistening in his eyes, Toby stared up at her. Then he shook his head. "Can you tell us what it was?"

This time there was no answer. Phillip Brookings rubbed at his chin.

"Mrs. Nelms, I don't know what to say. I saw Toby staring out my window, and I followed his line of sight. But there was no one there, nothing."

"Nothing?"

Brookings shook his head. "Just a big oak tree, a parking lot, and beyond it the emergency ward of the hospital. Nothing else. I'm sure of it."

The emergency ward. Barbara Nelms saw her son stiffen at the words.

"Toby, was that it? Was it the emergency ward?"

The boy remained mute. "Dr. Brookings, what would you suggest? " she asked. "Can you help us?"

The psychiatrist looked down at Toby. "Perhaps, " he said. "Perhaps with time I can. But I would like to insist on something before I begin."

"Anything."

"I want Toby to have a CT scan and a clean bill of health from a neurologist. As near as I can tell from reviewing the material you sent me, he has had neither. Correct?"

"I… I guess so."

"Well, if his attacks are some sort of seizure disorder, I think a neurologist should be involved, don't you?"

"Doctor, I told you when I first called, we're willing to do anything.

Absolutely anything. Is there someone you can recommend?"

Brookings nodded. "There's a new man in town. Yale Med. Trained at Harvard hospitals. He's a neurosurgeon, actually, but he's doing neurology as well. His name's Iverson. Zachary Iverson. I'll give him a call and then get back to you."

Barbara stroked her son's forehead. There was nothing in his expression to suggest he had followed any of their conversation. For a moment, studying the sunken hollows around his eyes and the tense, waxy skin over his cheeks, she felt as if she were looking at a corpse. "Please, Doctor, " she said, "just one thing."

"Yes?"

"Do it quickly."

Brookings nodded, and then rose and returned to his office. Barbara took her son by the hand and led him back to their car. Desperately, she searched her thoughts for any unpleasantness or difficulty he had encountered at Ultramed-Davis or in any other emergency ward. There was none. Nothing but a gashed chin when he was five and, of course, the incarcerated hernia operation last year. But Barbara Nelms knew-as the surgeon, Dr. Mainwaring, had told her-that the whole hernia affair had been as routine as routine could be.