Godplayer

Four

The next morning Cassi took her insulin and ate breakfast without any sign of Thomas. By eight she was concerned. Their usual schedule on Saturday was to leave by eight-fifteen so that Thomas could see his patients before Grand Rounds and Cassi could catch up on her own work.

Putting down the article she’d been reading at her desk and tightening the belt on her robe, Cassi walked from the morning room down the hall and listened outside Thomas’s door. There were no sounds whatsoever. She knocked softly and waited. Still nothing. She tried the door. It was unlocked. Thomas was sound asleep with his alarm clock gripped in his hand. Evidently he’d turned it off and fallen directly back to sleep.

Cassi walked over to him and shook him gently. There was no response. She shook him more forcibly and his heavy-lidded eyes opened, but he looked as if he didn’t recognize her.

“I’m sorry to wake you, but it’s already after eight. You do want to go to Grand Rounds, don’t you?”

“Grand Rounds?” answered Thomas with confusion. Then he seemed to understand. “Of course I want to go. I’ll be down for a bite in a few minutes. We’ll leave here in twenty at the most.”

“I’m not going to the hospital today,” said Cassi as brightly as she could. “I’m not expected in psychiatry, and I have an enormous amount to read. I brought home an entire bag full of reprints.”

“Suit yourself,” said Thomas, pushing himself up to a sitting position. “I’m on call tonight, so I’m not sure when I’ll be home. I’ll let you know later.”

Cassi went down to the kitchen to make something for Thomas to eat in the car.

Thomas sat on the edge of the bed while the room whirled around him. He waited until his vision cleared, feeling each pulse like a hammer in his head. He stumbled first to the desk where he got out one of his plastic containers. Then he made his way into the bathroom.

Avoiding his image in the mirror, Thomas tried to get one of the small, orange triangular pills out of the container. It was no easy task, and it wasn’t until he’d dropped several that he got one into his mouth and washed it down. Only then did he venture a glance at his face. It didn’t look as bad as he feared nor as bad as he felt. With a bit more agility he took another pill, stepped into the shower, and turned on the water full blast.

Cassi stood by the window in the living room watching as Thomas disappeared into the garage. Even through the glass she could hear the roar of the Porsche as it started. She wondered what it sounded like in Patricia’s apartment. The thought made her realize that she’d never visited Patricia; not once in the three years Cassi had been living there.

She watched until Thomas’s Porsche had accelerated down the driveway and disappeared into the damp morning fog that hung over the salt marsh. Even after the car was out of sight, its low-frequency roar could be heard as Thomas shifted gears. Finally the noise vanished and the stillness of the empty house enveloped Cassi.

Looking at her palms, Cassi noticed they were damp. Her first thought was that she was experiencing a mild insulin reaction. Then she realized it was nervousness. She was going to violate Thomas’s study. She’d always felt that trust and privacy were necessary parts of a close relationship, but she simply had to know if Thomas was taking tranquilizers or any other drugs. For months she’d been closing her eyes, hoping her marriage would improve. Now she knew she could not continue to wait passively any longer.

As she opened the door to Thomas’s study, she felt like a burglar: a very bad burglar. Each little sound in the house made her jump.

“My God,” said Cassi out loud. “You’re being an idiot!”

Her own voice had a calming effect. As Thomas’s wife she had the right to enter every room in the house. Yet in many ways she still felt like a visitor.

The study was in partial disarray. The sofa bed was still open, the covers piled in a heap on the floor. Cassi eyed the desk but then saw the open bathroom door. She pulled open the medicine cabinet. Inside were shaving gear, the usual litter of patented medicines, several old tooth-brushes, and some out-dated Tetracycline antibiotics. She looked through all the packages and containers. There was nothing remotely suspicious.

As she was about to leave, her eye caught a flash of color on the white-tiled floor. Bending down, she found herself holding a small triangular orange pill stamped with SKF-E-19. It looked familiar, but she couldn’t place it. Back in Thomas’s study she scanned the bookshelves for a Physician’s Desk Reference. Not finding one, she walked back to the morning room and took out her own. Quickly she turned to the product identification section. It was Dexedrine!

Holding the pill in her hand, Cassi stared out at the sea. There was a lone sailboat about a quarter mile out moving slowly through the swells. Watching it for a moment helped her organize her thoughts. She felt a weird mixture of relief and increased anxiety. The anxiety came from confirming her fear that Thomas might be taking drugs. The relief stemmed from the nature of the pill that she’d found-Dexedrine. Cassi could easily imagine an achiever like Thomas taking an occasional “upper” in order to sustain his almost superhuman performance. Cassi was aware of how much surgery Thomas did. She could understand how he could fall into the trap of taking a pill to sharpen his attention when he was otherwise exhausted. For Cassi it seemed to be in keeping with his personality. But as much as she tried to calm herself, she was still afraid. She knew the dangers of abusing Dexedrine and wondered how much she was to blame for Thomas’s need for the drug, and how long he’d been taking it.

She put the innocent pill down on the desk and returned the PDR to the shelf. For a moment she was sorry she’d gone into Thomas’s study and found the pill. It would have been easier to ignore the situation. After all, it was most likely a temporary problem, and if she said something to Thomas, he would only get angry.

“You’ve got to do something,” said Cassi, trying to build her resolve. As ridiculous as it seemed, the only person who exerted any kind of authority over Thomas’s life was Patricia. Although Cassi was reluctant to discuss the issue with anyone, at least she could expect Patricia to keep Thomas’s best interests at heart. Briefly weighing the advantages and disadvantages, she decided to discuss the situation with her mother-in-law. If Thomas had been abusing Dexedrine for a long time, someone should intervene.

The first thing she had to do, Cassi decided, was to make herself presentable. Pulling off her terry robe and her nightgown, she went to the shower.

Thomas enjoyed presenting cases at Grand Rounds. The entire departments of internal medicine and surgery attended, including residents and medical students. Today the MacPherson amphitheater was so full people had even been forced to sit on the steps leading up from the central pit. Thomas always drew a crowd even when, as today, he split the schedule with George.

As Thomas finished his talk, which had been titled “Long-Term Follow-Up of Patients Undergoing Coronary Bypass,” the entire amphitheater broke into enthusiastic applause. The sheer volume of Thomas’s work was enough to impress anyone, and given his good results, the statistics seemed superhuman.

When he opened up the floor for questions, someone from the upper tier yelled out that he’d like to know what kind of diet Thomas ate that gave him so much energy. The audience laughed heartily, eager for a morsel of humor.

When the laughter died down, Thomas concluded by saying: “I believe from the statistics I’ve presented there can no longer be any residual doubt as to the efficacy of the coronary bypass procedure.”

He gathered his papers and took a chair at the table behind the podium next to Dr. George Sherman.

The topic of George’s presentation was “An Interesting Teaching Case.”

Thomas inwardly groaned and glanced longingly at the exit. He had a splitting headache that had gotten progressively more intense after his arrival at the hospital. What a ridiculous topic, Thomas thought. He watched with mounting irritation as George made his way over to the podium and blew into the microphone to make sure it was on. As if that weren’t enough, he tapped it with his ring. Satisfied, he began to speak.

The case was a twenty-eight-year-old man by the name of Jeoffry Washington who’d contracted acute rheumatic fever at age ten. He’d been a sick child at the time and hospitalized for an extended period. When the acute disease had run its course, the child had been left with a loud holosystolic heart murmur, indicating his mitral valve had been severely damaged. Over the years the problem gradually worsened to the point that an operation was needed to replace the damaged valve.

At that point Jeoffry Washington was wheeled in and presented to the audience. He was a slight, callow-appearing Negro with angular, precise features, bright eyes, and skin the color of blond oak. He held his head back and stared up into the multitude of faces that were looking down at him.

As Jeoffry was wheeled back out, Thomas’s and Jeoffry’s eyes happened to meet. Jeoffry nodded and smiled. Thomas returned the gesture. Thomas couldn’t help feeling sorry for the young man. Yet as tragic as his story was it was also quite common. Thomas had personally operated on hundreds of patients with similar histories.

With Jeoffry gone, George returned to the podium. “Mr. Washington has been scheduled to have a mitral valve replacement, but during the work-up an interesting fact was uncovered. Mr. Washington had an episode of pneumocystic carini pneumonia one year ago.”

An excited murmur rippled through the audience.

“I suppose,” called George over the babble of voices, “that it is not necessary to remind you that such an illness suggested AIDS, or Acquired Immune Deficiency Syndrome, which was indeed found in this patient. As it turns out, Jeoffry Washington’s sexual preferences have placed him in that group of homosexual men whose life-style has apparently led to immuno-suppression.”

Thomas now knew what George had meant by his comment in the surgical lounge the previous afternoon. He closed his eyes and tried to control his rising anger. Obviously Jeoffry Washington was an example of the kind of case that was taking OR slots and cardiac surgical beds away from Thomas’s patients. Thomas was not alone in his reservations concerning operating on Jeoffry. One of the internists raised his hand and George recognized him. “I would seriously question the rationale for elective heart surgery in light of the patient’s having AIDS,” said the internist.

“That’s a good point,” said George. “I can say that Mr. Washington’s immunological picture is not grossly abnormal at present. He’s scheduled for surgery next week, but we will be following his helper T-cell and cytotoxic T-cell populations for any sudden decline. Dr. Sorenson of the department of immunology does not think the AIDS is an absolute contraindication for surgery at this time.”

A number of hands popped up in the audience, and George began to call on them. The animated discussion took the conference over its normal time, and even after it was officially over, groups of people stood in clumps to continue talking.

Thomas tried to leave immediately, but Ballantine had gotten up and blocked his way. “Good conference,” he beamed.

Thomas nodded. All he wanted to do was get away. His head felt as if it were in a vise.

George Sherman came up behind Thomas and clapped him on the back. “You and I really entertained them this morning. We should have charged admission.”

Thomas slowly turned to face George’s smiling, self-satisfied face. “To tell you the honest truth, I think the conference was a goddamn farce.”

There was an uncomfortable silence as the two men eyed one another in the midst of the crowd.

“Okay,” said George at length. “I suppose you are entitled to your opinion.”

“Tell me. Is this poor fellow, Jeoffry Washington, whom you paraded out here like some freak, occupying a cardiac surgical bed?”

“Of course,” said George, his own ire rising. “Where do you think he’d be, in the cafeteria?”

“All right, you two,” said Ballantine.

“I’ll tell you where he should be,” snapped Thomas while he jabbed George in the chest with his index finger. “He should be on the medical floor in case something can be done about his immunological problem. Having already had pneumocystic carini pneumonia there’s a good chance he’ll be dead before he ever gets into a life-threatening cardiac state.”

George knocked Thomas’s hand aside. “As I said, you’re entitled to your opinion. I happen to think Mr. Jeoffry Washington is a good teaching case.”

“Good teaching case,” scoffed Thomas. “The man is medically ill. He should not be taking up a scarce cardiac surgical bed. The bed is needed for others. Can’t you understand that? It’s for this kind of nonsense that I have to keep my patients waiting, patients with no medical problems, patients who will be making real contributions to society.”

George again knocked Thomas’s hand away. “Don’t touch me like that,” he snapped.

“Gentlemen,” said Ballantine, stepping between them.

“I’m not sure Thomas knows what the word means,” said George.

“Listen, you little shithead,” snarled Thomas, reaching around Ballantine and grabbing a handful of George’s shirt. “You’re making a mockery of our program with the cases you’re dredging up just to keep the so-called teaching schedule full.”

“You’d better let go of my shirt,” warned George, his face suffused with color.

“Enough,” shouted Ballantine, pulling Thomas’s hand away.

“Our job is to save lives,” said George through gritted teeth, “not make judgments about who is more worthy. That’s up to God to decide.”

“That’s just it,” said Thomas. “You’re so stupid you don’t even realize that you are making judgments about who should live. The trouble is your judgment stinks. Every time you deny me OR space another potentially healthy patient is condemned to death.”

Thomas spun on his heels and strode from the room.

George took a deep breath, then adjusted his disheveled shirt.

“God! Kingsley is such a prig.”

“He is arrogant,” agreed Ballantine. “But he is such a damn good surgeon. Are you all right?”

“I’m fine,” said George. “I must admit I came close to slugging him. You know, I think he’s going to be trouble. I hope he doesn’t get suspicious.”

“In that sense his arrogance will be a help.”

“We’ve been lucky. By the way, have you ever noticed Thomas’s tremor?”

“No,” said Ballantine with surprise. “What tremor?”

“It’s on and off,” said George. “I’ve noticed it for about a month, mainly because he was always so steady. I even noticed it today when he was doing his presentation.”

“Lots of people are nervous in front of groups.”

“Yeah,” said George, “but it was the same as when I was talking to him about the Wilkinson death.”

“I’d rather not talk about Wilkinson,” said Ballantine, glancing around at the slowly emptying amphitheater. He smiled at an acquaintance. “Thomas is probably just tense.”

“Maybe,” said George, not convinced. “I still think he’s going to be trouble.”

Cassi dressed for her visit to Patricia as if it were the first time they were to meet. With great care she chose a dark blue wool skirt with a matching jacket to go over one of her high-necked white blouses. Just as she was about to leave, she noticed the atrocious state of her nails and thankfully postponed the visit while she removed her old polish and applied a new coat. When that was dry, she decided she didn’t like her hair, so she took it down and put it back up again.

Finally having run out of reasons to delay, she crossed the courtyard between the house and the garage. It was freezing out. Ringing Patricia’s bell, Cassi could see her breath in the crisp air. There was no answer. Standing on tiptoes, she looked through a small window in the door, but all she could see was a flight of stairs. She tried the bell again, and this time saw her mother-in-law slowly descend the stairs and peer out through the glass. “What is it, Cassandra?” she called.

Nonplussed that Patricia didn’t open the door, Cassi was silent for a minute. Under the circumstances she didn’t feel like shouting her reason for visiting. Finally she said: “I want to talk to you about Thomas.”

Even with that explanation there was a long enough pause for Cassi to wonder if Patricia had heard her. Then several bolts snapped aside and the door opened. For a moment the two women eyed each other.

“Yes,” said Patricia finally.

“I’m sorry to bother you,” began Cassi. She let her sentence trail off.

“You’re not bothering me,” said Patricia.

“Could I come in?” asked Cassi.

“I suppose,” said Patricia, starting up the stairs. “Be sure and close the door.”

Cassi was glad to close the door on the cold, damp morning. Then she climbed after Patricia and found herself in a small apartment sumptuously furnished in Victorian red velvet and white lace.

“This room is beautiful,” said Cassi.

“Thank you,” said Patricia. “Thomas’s favorite color is red.”

“Oh?” said Cassi, who had always thought Thomas partial to blue.

“I spend a lot of time here,” said Patricia. “I wanted it comfortable and warm.”

“It is that,” admitted Cassi, seeing for the first time a rocking horse, a kiddy car, and other toys.

Patricia, as if following Cassi’s glance, explained: “Those are some of Thomas’s old toys. I think they’re rather decorative, don’t you?”

“I do,” said Cassi. She thought the toys did have a certain appeal but looked a little out of place in the lavish setting.

“How about some tea?” suggested Patricia.

Suddenly Cassi realized that Patricia was as uncomfortable as she was.

“Tea would be very nice,” said Cassi, feeling more at ease herself.

Patricia’s kitchen was utilitarian, with white metal cabinets, an old refrigerator, and a small gas stove. Patricia put on the kettle and got out her china. From the top of the refrigerator she produced a wooden tray.

“Milk or lemon?” asked Patricia.

“Milk,” said Cassi.

Watching her mother-in-law search for a creamer, Cassi realized how few visitors the older woman saw. With a touch of guilt Cassi wondered why they hadn’t become better friends. She tried to bring up Thomas’s problem, but the rift that had always existed between them silenced her. It wasn’t until they’d seated themselves in the living room with full teacups that Cassi finally got the courage to begin. “The reason I came over here this morning was to talk to you about Thomas.”

“That’s what you said,” replied Patricia pleasantly. The old woman had warmed considerably and seemed to be enjoying the visit.

Cassi sighed and put her teacup down on the coffee table. “I’m concerned about Thomas. I think he is pushing himself too hard and…”

“He’s been that way since he was a toddler,” interrupted Patricia. “That boy was a hyperactive high achiever from the day he was born. And I tell you it was a twenty-four-hour-a-day job keeping him in line. Even before he could walk he was his own boss, and I had a devil of a time disciplining him. In fact from the day I brought him home from the hospital…”

Listening to Patricia’s stories, Cassi realized exactly how central Thomas still was to the older woman’s world. It finally made sense to her why Patricia insisted on living where she did, even though it was so isolated. Watching her mother-in-law pause to sip her tea, Cassi noted how strongly Thomas resembled Patricia. Her face was thinner and more delicate, but there was the same aristocratic angularity.

Cassi smiled. When Patricia put her cup back down, Cassi said, “Sounds like Thomas hasn’t changed much.”

“I don’t think he’s changed at all,” said Patricia. Then with a laugh she added, “He’s been the same boy all his life. He’s needed a lot of attention.”

“What I was hoping,” said Cassi, “is that you might help Thomas now.”

“Oh?” said Patricia.

Cassi could see the newly gained intimacy rapidly revert to the old suspiciousness. But she forged on. “Thomas listens to you and…”

“Of course he listens to me. I’m his mother. What exactly are you leading up to, Cassandra?”

“I have reason to suspect that Thomas may be taking drugs,” said Cassi. It was a relief to finally get it out. “I’ve suspected it for a few months but hoped the problem would just go away.”

Patricia’s blue eyes became cold. “Thomas has never taken drugs,” she said.

“Patricia, please understand me. I’m not just criticizing. I’m worried, and I think you might be able to help. He does what you tell him to do.”

“If Thomas needs my help, then he should come and ask for it himself. After all, he chose you over me.” Patricia stood up. As far as she was concerned, the little tête-à-tête was over.

So that was it. Patricia was still jealous that her little boy had grown up enough to take a wife.

“Thomas didn’t choose me over you, Patricia,” said Cassi evenly. “He was looking for a different relationship.”

“If it is such a different relationship, where are the children?”

Cassi could feel her strength of will drain away. The whole issue of children was a sensitive and emotional one for her, since juvenile diabetics were cautioned against the risk of pregnancy. She looked down at her tea, realizing she never should have tried speaking to her mother-in-law.

“There won’t be any children,” said Patricia, answering her own question. “And I know why not. Because of your illness. You know it’s a tragedy for Thomas to be childless. And he tells me you’ve been sleeping apart lately.”

Cassi lifted her head, shocked that he would reveal such intimate matters. “I know Thomas and I have our problems,” she said. “But that’s not the issue. I’m afraid he is taking a drug called Dexedrine and that he has probably been taking it for some time. Even though he does it just to work harder, it can be dangerous both to him and his patients.”

“Are you accusing my son of being an addict?” snapped Patricia.

“No,” said Cassi, unable to explain further.

“Well, I should hope not,” said Patricia. “Lots of people take a pill now and then. And for Thomas it is understandable. After all, he’s been driven from his own bed. I think your relationship is the real problem.”

Cassi didn’t have the strength to fight back. She sat silently wondering if Patricia was right.

“Furthermore I think you should go,” said Patricia, reaching across and taking Cassi’s cup.

Without another word Cassi got up, descended the stairs, and let herself out.

Patricia collected the teacups and carried them into the kitchen. She had tried to tell Thomas that marrying that girl was a mistake. If only he had listened.

Back in the living room Patricia sat down at the telephone and called Thomas’s exchange. She left a message for him to call his mother as soon as possible.

Thomas’s patients were inconveniently sprinkled on all three surgical floors. After Grand Rounds he’d taken the elevator to the eighteenth to work his way down. Normally on Saturdays, he liked to make rounds before the conference and before visiting hours. But today he’d arrived at the hospital late and consequently lost a lot of time reassuring nervous families. They would follow him out of the room and stand asking questions in the hall until in desperation he cut them off to examine his next patient only to be further delayed by that person’s relatives.

It was a relief to reach the ICU where visitors were rarely allowed. As he pushed through the door he allowed himself to think about the regrettable episode with George Sherman. As understandable as his reaction was, Thomas was surprised and disappointed in himself.

In the ICU, Thomas checked on the three patients he’d operated on the day before. All were fine. They’d been extubated and had taken something by mouth. EKGs, blood pressures, and all other vital signs were stable and normal. Mr. Campbell had had a few brief episodes of an irregular cardiac rhythm but that had been controlled when an astute resident found some unrelieved gastric dilation. Thomas got the fellow’s name. He wanted to compliment him next time he had the opportunity.

Thomas walked over to Mr. Campbell’s bed. The man smiled weakly. Then he started to speak.

Thomas bent over. “What did you say, Mr. Campbell?”

“I have to urinate,” said Mr. Campbell softly.

“You have a catheter in your bladder,” said Thomas.

“I still have to urinate,” said Mr. Campbell.

Thomas gave up. He’d let the nursing staff argue with Mr. Campbell.

As he turned to leave, he glanced at the sorry case in the bed next to Mr. Campbell. It was one of Ballantine’s disasters. The patient had embolized air to the brain during the operation and now was no more than a living vegetable totally dependent on a breathing machine, but with the quality of the nursing care at the Memorial, he could be expected to live indefinitely.

Thomas felt an arm on his shoulder. He turned and was surprised to find George Sherman.

“Thomas,” began George. “I think it is healthy that we have disagreements if only because it might force us to examine our own positions. But it upsets me to think there has to be animosity.”

“I was embarrassed at my own behavior,” said Thomas. That was as close as he could come to an apology.

“I got a bit hot under the collar myself,” admitted George. He let his eyes leave Thomas’s face, noticing which bed Thomas had stopped at. “Poor Mr. Harwick. Talk about a shortage of beds. Here’s another one we could use.”

Thomas smiled in spite of himself.

“Trouble is,” added George, “Mr. Harwick is going to be here for a long time unless…”

“Unless what?” asked Thomas.

“Unless we pull the plug, as they say,” George smiled.

Thomas tried to leave, but George gently restrained him.

Thomas wondered why the man felt obligated to touch him all the time.

“Tell me,” asked George. “Would you have the courage to pull the plug?”

“Not unless I talked with Rodney Stoddard first,” said Thomas sarcastically. “What about you, George? You seem willing to do most anything to get more beds.”

George laughed and withdrew his arm. “We all have our secrets, don’t we? I never expected you to say that you’d talk to Rodney. That’s a good one.” George gave Thomas another of his little taps and walked away, waving good-bye to the ICU nurses.

Thomas watched him, then glanced back at the patient, thinking over George’s comments. From time to time a brain-dead patient was taken off his life support system, but neither doctors nor nurses acknowledged the fact.

“Dr. Kingsley?”

Thomas turned to face one of the ICU clerks.

“Your service is on the line.”

Giving Ballantine’s patient one last glance, Thomas walked over to the central desk wondering how he could get Ballantine to refer his difficult cases. Thomas was confident these “unanticipated” and “unavoidable” tragedies would not happen if he did the surgery.

Thomas answered the phone with undisguised irritation. Invariably when the answering service looked for him it meant bad news. This time, however, the operator just said that he should call his mother as soon as he could.

Perplexed, Thomas made the call. His mother never called him during the day unless it was something important.

“Sorry to bother you, dear,” said Patricia.

“What is it?” asked Thomas.

“It’s about your wife.”

There was a pause. Thomas could feel his patience evaporating.

“Mother, I happen to be rather busy.”

“Your wife paid me a visit this morning.”

For a fleeting moment Thomas thought that Cassi might have mentioned his impotence. Then he realized that was absurd. But his mother’s next statement was even more alarming.

“She was suggesting you were some kind of addict. Dexedrine, I think she said.”

Thomas was so angry he could barely speak.

“Wha-what else did she say?” he finally stammered.

“I think that’s rather enough, don’t you? She said you were abusing drugs. I warned you about this girl, but you wouldn’t listen to me. Oh, no. You knew better…”

“I’ll have to talk to you tonight,” said Thomas, disconnecting the line with his index finger.

Still gripping the receiver, Thomas struggled to control his rage. Of course he took a pill now and then. Everybody did. How dared Cassi betray him by making a big deal of the fact to his mother? Abusing drugs! My God, an occasional pill didn’t mean he was an addict.

Impulsively Thomas dialed Doris at home. She answered on the third ring out of breath.

“How about a little company?” asked Thomas.

“When?” asked Doris enthusiastically.

“In a few minutes. I’m at the hospital.”

“I’d love it,” said Doris. “I’m glad you caught me. I was just on my way upstairs.”

Thomas hung up. He felt a twinge of fear. What if the same thing happened with Doris as happened last night with Cassi? Knowing it was better not to think about it, Thomas hurried through the rest of his rounds.

Doris lived only a couple of blocks from the hospital on Bay State Road. As Thomas walked to her apartment, he could not stop thinking about what Cassi had done. Why would she want to provoke him like that? It didn’t make sense. Did she really think he wouldn’t find out? Maybe she was trying to get back at him in some illogical way. Thomas sighed. Being married to Cassi had not been the dream he’d envisioned. He’d thought she was going to be such an asset. So many people had swooned over her that he’d been convinced she was something special. Even George had been crazy for her, wanting to marry her after a handful of dates.

Doris’s voice mixed with static greeted him over the intercom when he pushed her bell. He started up the stairs and heard her door open.

“What a nice surprise,” she called as he rounded the first landing. She was dressed in a skimpy jogging outfit of shorts and a T-shirt that barely covered her navel. Her hair was loose and seemed incredibly thick and shiny.

As she led him inside and closed the door, Thomas glanced around the apartment. He hadn’t been there for months, but not much had changed. The living room was tiny, with a single couch facing a small fireplace. At the end of the room was a bay window that overlooked the street. On the coffee table were a decanter and two glasses. Doris walked up to Thomas and leaned against him. “Did you want to dictate a little?” she teased, running her hands down his back. Thomas’s fears about his potency quickly vanished.

“It’s not too early for a little fun, is it?” asked Doris, pressing herself against Thomas and sensing his arousal.

“God, no,” said Thomas, pulling her down onto the couch and yanking off her clothes in an ecstasy of excitement and relief at his own response. As he plunged into her he comforted himself that the problem that he’d experienced the night before was Cassi’s, not his. It never occurred to him that he had yet to take a Percodan that day.

The nurses in the surgical intensive care unit knew that problems, particularly serious problems, had an uncanny way of propagating themselves. The night had begun badly with the eleven-thirty arrest of an eleven-year-old girl who’d been operated on that day for a ruptured spleen. Luckily things had worked out well, and the child’s heart had begun beating again almost immediately. The nurses had been amazed at the number of doctors who had responded to the code. For a time there had been so many doctors that they’d been falling over each other.

“I wonder why there are so many attendings in the house?” asked Andrea Bryant, the night supervisor. “It’s the first time I’ve seen Dr. Sherman here on a Saturday night since he was a resident.”

“Must be a lot of emergency cases in the OR,” said the other RN, Trudy Bodanowitz.

“That can’t be it,” said Andrea. “I spoke to the night supervisor there and she said that there were only two: an emergency cardiac case and a fractured hip.”

“Beats me,” said Trudy, looking at her watch. It was just after midnight. “Do you want to take first break tonight?”

The girls were sitting at the central desk finishing the paperwork engendered by the arrest. Neither was assigned to specific patients but rather manned the central station and performed the necessary administrative functions.

“I’m not sure either of us is going to get a break,” said Andrea, looking around the large U-shaped desk. “This place is a mess. There’s nothing like having an arrest right after shift change to spoil routine.”

The nurses’ station in the ICU rivaled the flight deck of a Boeing 747 for complicated electronic equipment. Facing the women were banks of TV screens giving constant read-outs on all the patients in the unit. Most were set within certain limits so that alarms would go off if the values strayed too far from normal. While the women were speaking, one of the EKG tracings was changing. As crucial minutes passed, the previously regular tracing began to look more and more erratic. Finally, the alarm went off.

“Oh shit,” said Trudy as she looked up at the beeping oscilloscope screen. She stood up and gave the unit a slap with her hand, hoping that an electrical malfunction was the cause of the alarm. She saw the abnormal EKG pattern and switched to another lead, still hoping the problem was mechanical.

“Who is it?” asked Andrea, checking for any evidence of frantic activities on the part of the nursing staff.

“Harwick,” said Trudy.

Andrea’s gaze quickly switched over to the bed of Dr. Ballantine’s OR disaster. There was no nurse in attendance, which was not unusual. Mr. Harwick had been exceptionally stable over the last weeks.

“Call the surgical resident,” said Trudy. Mr. Harwick’s EKG was deteriorating even as Trudy watched. “Look at this, he’s going to arrest.”

She pointed to the screen where Mr. Harwick’s EKG was showing typical changes before it either stopped or degenerated to ventricular fibrillation.

“Should I call a code?” asked Andrea.

The two women looked at each other.

“Dr. Ballantine specifically said ‘no code,’ ” said Trudy.

“I know,” said Andrea.

“It always gives me an awful feeling,” said Trudy, looking back at the EKG. “I wish they wouldn’t put us in this position. It’s not fair.”

While Trudy watched, the EKG line flattened out with just an occasional blip. Mr. Harwick had died.

“Call the resident,” said Trudy angrily. She walked around the end of the ICU desk and approached Mr. Harwick’s bed. The respirator was still inflating and deflating his lungs, giving him the appearance of life.

“Certainly doesn’t make you excited about having surgery,” said Andrea, hanging up the phone.

“I wonder what went wrong. He was so stable,” said Trudy.

Trudy reached out and flipped off the respirator. The hissing sound stopped. Mr. Harwick’s chest fell and was still.

Andrea reached over and turned off the IV. “It’s probably just as well. Now the family can adjust and then go on with their lives.”