Godplayer

Five

Two weeks had passed since Thomas learned of Cassi’s visit to his mother. While they had only fought briefly, the tension had been unbearable. Even Thomas had noted his increased dependency on Percodan, but he had to take something to allay his anxiety.

As he ran down the hall late for the monthly death conference, he felt his pulse race.

The meeting had already begun, and the chief surgical resident was presenting the first case, a trauma victim who had expired shortly after admission to the ER. The resident and intern had failed to notice warning signs that the sac covering the heart had been damaged and was filling with blood. Since no attending had been involved, the doctors happily raked the house staff over the coals.

If the case had belonged to one of the private staff men, the discussion would have progressed very differently. The same points would have been made, but the physician would have been reassured that the diagnosis of hemopericardium was difficult and he’d done the best he could.

Thomas had realized early in the game that the monthly death conference served more to relieve guilt than to punish, unless the offender was a resident. Lay people might have thought the death conference served as a kind of watchdog, but unfortunately such was not the case, as Thomas cynically observed. And the next case proved his point.

Dr. Ballantine was mounting the podium to present Herbert Harwick. When he finished, an obese pathology resident quickly ran down the results of the autopsy, including slides of the individual’s brain, of which little remained.

Mr. Harwick’s death was then discussed but with no mention that his trauma in the OR was the possible result of Dr. Ballantine’s inept surgery. The general feeling among the attendings was, “There but for the grace of God go I,” which was true to an extent. What made Thomas sick was that no one remembered that six months previously Ballantine had presented a similar case. Air embolism was a feared complication that at times occurred no matter what one did, but the fact that it occurred so often and at an increasing frequency to Ballantine was always ignored.

Equally amazing, as far as Thomas was concerned, was that nothing was said about Harwick’s actual death in the ICU. As far as Thomas knew, the patient had been stable for an extended period of time before the sudden arrest. Thomas looked at the members of the audience and puzzled why they remained silent. It reconfirmed for him that bureaucracy and its committee method of dealing with problems was no way to run an organization.

“If there’s no further discussion,” said Ballantine, “I think we should move on to the next case. Unfortunately I’m still in the dock.” He smiled thinly. “The patient’s name is Bruce Wilkinson. He is a forty-two-year-old white male who had suffered a heart attack and who had shown focally compromised coronary circulation, suggesting he was a good candidate for a triple bypass procedure.”

Thomas straightened up in his chair. He remembered Wilkinson very clearly, particularly the night he’d attempted to resuscitate him. He could still see the surrealistic scene in his mind’s eye.

Ballantine droned on, presenting the case with much too much detail. The chin of the surgeon sitting next to Thomas slumped onto his chest and his deep, regular breathing could be heard as far away as the podium. Finally Ballantine got to the end and said, “Mr. Wilkinson did extremely well postoperatively until the night of the fourth postoperative day. At that time he died.”

Ballantine looked up from his papers. His face, in contrast to its expression when they were discussing the previous case, had assumed a defiant expression as if to say, “Try to find a mistake here.”

A slight, well-dressed pathology resident got up from the first row and stepped behind the podium. He adjusted the small microphone nervously and bent over, thinking he had to speak directly into it. A high-pitched, irritating electronic sound resulted, and he backed away with apology.

Thomas recognized the man. It was Robert Seibert, Cassi’s friend.

As soon as Robert began his presentation of the pathology, all evidence of his nervousness disappeared. He was a good speaker, especially when compared with Ballantine, and he had organized his material so that only the significant points were mentioned. He showed a series of slides and pointed out that, although the patient had been described as having been deeply and grossly cyanotic at the time of death, there was no airway obstruction. He next presented a photomicrograph that showed that there was no alveolar problem in the lungs. Another series of slides showed there were no pulmonary emboli. Another series of photomicrographs was presented that showed there was no evidence that there had been a rise in left or right atrial pressure prior to death. The final series of pictures indicated that the bypasses were skillfully sutured in place and that there was no sign of recent myocardial infarction or heart attack.

The lights came back on.

“All this shows…” said Robert, pausing as if for effect, “that there was no cause of death in this case.”

The audience responded with surprise. Such a statement was completely unexpected. There were even a few laughs as well as a comment from one of the orthopedic men who asked if this had been one of those cases that had awakened in the morgue. That inspired more laughter. Robert smiled.

“Must have been a stroke,” said someone behind Thomas.

“That is a good suggestion,” said Robert. “A stroke that shut down the breathing while the heart pumped the unoxygenated blood. That would cause deep cyanosis. But that would mean a brain-stem lesion. We went over the brain millimeter by millimeter and found nothing.”

The audience was now silent.

Robert waited for more comments, but there were none. Then he leaned forward and spoke into the microphone: “With permission I’d like to present another slide.”

Cleverly he’d caught the imagination of the gathering.

Thomas had an idea of what was coming.

Robert switched off the lights, then switched on the projector. The slide showed a compilation of seventeen cases, containing comparable data on age, sex, and points of medical history.

“I’ve been interested in cases such as Mr. Wilkinson for some time,” said Robert. “This slide is to show that his is not an isolated case. I have found four similar cases myself over the last year and a half. When I went back in the files, I found thirteen others. If you’ll notice, they have all had cardiac surgery. In each circumstance, no specific cause of death was found. I’ve labeled this syndrome sudden surgical death, or SSD.”

The lights came back on.

Ballantine’s face had turned bright red. “What do you think you are doing?” he spat at Robert.

Under different circumstances Thomas might have felt sorry for Robert. His unexpected presentation did not fit within the rather narrow protocol for a death conference.

Glancing around the room, Thomas saw many angry faces. It was an old story. Doctors did not like to have their expertise questioned. And they were reluctant to police their own.

“This is a death conference, not a Grand Rounds,” Ballantine was saying. “We’re not here for a lecture.”

“In discussing the case of Mr. Wilkinson, I thought it would be enlightening…”

“You thought,” repeated Dr. Ballantine sarcastically. “Well, for your information you’re here as a consult. Did you have something specific to say when you presented this list of supposed sudden surgical deaths?”

“No,” admitted Robert.

Although Thomas preferred to stay silent at such meetings, he had to ask a question: “Excuse me, Robert,” he called. “Did all the seventeen cases have deep cyanosis?”

Robert could not have been more eager to field a question from the audience. “No,” he said into the microphone. “Only five of the cases.”

“That means that the physiologic cause of death was not the same in all these cases.”

“That’s true,” said Robert. “Six had convulsions prior to death.”

“That was probably air embolism,” said another surgeon.

“I don’t think so,” said Robert. “First of all, the convulsions occurred three or more days after surgery. It would be hard to explain that kind of delay. Also when the brains were autopsied, no air was found.”

“Could have been absorbed,” said someone else.

“If there had been enough air to cause sudden convulsions and death,” said Robert, “then there should have been enough to see.”

“What about the surgeons?” called the man behind Thomas. “Were any more heavily represented than others?”

“Eight of the cases,” said Robert, “belonged to Dr. George Sherman.”

A buzz of conversation broke out in the back of the room. George rose furiously to his feet as Ballantine nudged Robert from the podium.

“If there are no further comments…” said Ballantine.

George spoke out: “I think Dr. Kingsley’s comment was particularly cogent. By pointing out that there were different mechanisms of death in these cases, he indicated that there was no reason to try and relate the cases.” George looked over at Thomas.

“Exactly,” said Thomas. He would have preferred to let George sink or swim on his own, but he felt obligated to respond. “It occurred to me that Robert had correlated the cases because of some similarity he saw in their deaths, but that didn’t seem to be the case.”

“The basis of the correlation,” said Robert, “was that the deaths, particularly over the last several years, occurred when the patients were apparently doing well, and there was no anatomic or physiologic cause.”

“Correction,” said George. “No cause was found by the department of pathology.”

“It’s the same thing,” said Robert.

“Not quite,” said George. “Maybe another pathology department would have found the causes. I think it’s more of a reflection on you and your colleagues than anything else. And intimating that there is something irregular about a series of operative tragedies on such a basis is irresponsible.”

“Hear, hear,” shouted an orthopedic surgeon who began to clap. Robert quickly stepped down from the podium. There was an air of tension in the room.

“The next death conference will be one month from today, January seventh,” said Ballantine, switching off the microphone and gathering his papers. He walked off the stage and over to Thomas.

“You seemed to know that kid,” he said. “Who the hell is he?”

“His name is Robert Seibert,” said Thomas. “He’s a second-year pathology resident.”

“I’m going to have the kid’s balls in Formalin. Who does the little turd think he is, coming up here and putting himself up as our Socratic gadfly?”

Over Ballantine’s shoulder, Thomas could see George making his way over to them. He was just as provoked as Ballantine.

“I got his name,” said George menacingly, as if he were revealing a secret.

“We already know it,” said Ballantine. “He’s only in his second year.”

“Wonderful,” said George. “Not only do we have to put up with philosophers, but also smart-ass pathology residents.”

“I heard there was a death this month in one of the cath rooms in radiology,” said Thomas. “How come it wasn’t presented?”

“Oh, you mean Sam Stevens,” said George nervously, watching Robert leave the room. “Since the death occurred during the catheterization, the medical boys wanted to present it at their death conference.”

While Thomas watched Dr. Ballantine and George fume, he wondered what they’d say if he told them that Cassi had been involved with the so-called SSD study. For everyone’s sake he hoped they wouldn’t find out. He also hoped that Cassi had had sense enough not to continue her association with Robert. All it could do was cause trouble.

In a totally dark examination room, Cassi was lying flat on her back and could not have been more uncomfortable. She wasn’t in pain but close to it as she was forced to keep her eye still while Dr. Martin Obermeyer, chief of ophthalmology, shined an intensely bright light into her left eye. Worse than the discomfort was her fear of what the doctor would say. Cassi knew she’d been less than responsible about her eye problem. Desperately she hoped that Dr. Obermeyer would make some reassuring comment as he examined her. But he remained ominously quiet.

Without so much as a word, he shifted the light into her good eye. The beam came from an apparatus that the doctor wore around his head, similar to a miner’s light, but more intricate. Although the light seemed bright in her left eye, when it shifted to the good eye the intensity was so great it was difficult for Cassi to believe it did not cause damage in and of itself.

“Please, Cassi,” said Dr. Obermeyer, lifting the light beam and peering at her beneath the eyepieces of the instruments. “Please hold your eye still.” He pressed down with a small metal stylus.

Irritative tears welled up, and Cassi could feel them spill over and run down the side of her face. She wondered how much longer she could stand it. Involuntarily she gripped the sheet covering the examining table. Just at the moment she thought she could no longer remain still, the light disappeared, but even after Dr. Obermeyer turned on the overhead lights, she could not see well. The doctor was a blur to her as he sat down at his desk to write.

It concerned her that he was being so reticent. Obviously he was annoyed at her.

“Can I sit up?” asked Cassi hesitatingly.

“I don’t know why you ask my opinion,” said Dr. Obermeyer, “when you don’t follow any of my other suggestions.” The ophthalmologist didn’t bother turning around as he spoke.

Cassi sat up and swung her legs over the side of the table. Her right eye was beginning to correct itself from the trauma of the bright light, but her vision remained blurry from the drops used to dilate her pupils. She watched Dr. Obermeyer’s back for a moment, digesting his comment. She’d expected him to be annoyed that she’d canceled her last appointment, but she hadn’t thought it would be this bad.

Only after he finished writing and closed his chart did he turn back to Cassi. He was sitting on a low stool with wheels, and he glided over to face her.

Cassi’s line of vision from her perch on the exam table was a good foot higher than the doctor’s. She could see the shiny area on the top of his head where his hair was thinning. He wasn’t the world’s best-looking man, with his full, heavy features and a deep line in the middle of his forehead. Yet the whole package was not unattractive. His face exuded intelligence and sincerity, two qualities that Cassi found appealing.

“I think I should be frank,” he began. “There is no sign of the blood clearing from your left eye. In fact it appears as if there is new blood.”

Cassi tried not to betray her anxiousness. She nodded as if she were listening to a discussion of another patient.

“I still cannot visualize the retina,” said Dr. Obermeyer. “Consequently I do not know where the blood is coming from or if it is a treatable lesion.”

“But the ultrasound test…” began Cassi.

“It proved that the retina is not detached, at least not yet, but it cannot show where the bleeding is coming from.”

“Perhaps if we waited a little longer.”

“If it hasn’t cleared by now, it’s extremely unlikely that it will. Meanwhile we could lose the only chance we have to treat. Cassi, I’ve got to see the back of your eye. We must do a vitrectomy.”

Cassi glanced away. “It can’t wait for a month or so?”

“No,” said Dr. Obermeyer. “Cassi, you have already gotten me to postpone this longer than I wanted to. Then you canceled your last appointment. I’m not sure you understand the stakes here.”

“I understand the stakes,” said Cassi. “It’s just not a good time.”

“It’s never a good time for surgery,” said Dr. Obermeyer, “except for the surgeon. Let me schedule this thing and get on with it.”

“I have to discuss it with Thomas,” said Cassi.

“What?” questioned Dr. Obermeyer with surprise. “You haven’t told him about this?”

“Oh yes,” said Cassi quickly. “Just not the timing.”

“When can you discuss the timing with Thomas?” asked Dr. Obermeyer with resignation.

“Soon. In fact tonight. I’ll be back to you tomorrow, I promise.” She slid off the table and steadied herself.

Cassi was relieved to escape from the ophthalmologist’s office. Deep down she knew he was right; she should have the vitrectomy. But telling Thomas was going to be difficult. Cassi stopped at the end of the corridor on the fifth floor of the Professional Building, the same building where Thomas had his office. She stared out a window at the early December cityscape with its leafless tree-lined streets and densely packed brick buildings.

An ambulance was screaming down Commonwealth Avenue, its lights flashing. Cassi closed her right eye, and the scene vanished to mere light. In a panic she reopened her eye to let the world back in. She had to do something. She had to talk with Thomas despite the difficulties they’d had since her visit to Patricia.

Cassi wished that Saturday two weeks previously had never taken place. If only Patricia had not called Thomas. But of course that had been too much to ask. Expecting Thomas to come home angry, Cassi was shocked when he didn’t come home at all. At ten-thirty, Cassi had finally called Thomas’s exchange. Only then did she learn that Thomas had an emergency operation. She left word for him to call and waited up until two, finally falling asleep with book in hand and light on. Thomas finally came home on Sunday afternoon and, instead of screaming at her, refused to talk to her at all. With deliberate calm he moved his clothes into the guest room next to his study.

For Cassi the “silent treatment” was an unbearable strain. What little conversation they did have was just chatter. Dinner was the worst, and several times Cassi, pleading a headache, took a tray to her room.

After a week, Thomas had finally exploded in a rage. The triggering event had been insignificant; Cassi had dropped a Waterford glass on the tiled kitchen floor. As Thomas rushed over to her and started yelling, he accused Cassi of being deceitful and maneuvering behind his back. How dare Cassi go to his mother and accuse him of drug abuse?

“Of course I’ve taken an occasional pill,” said Thomas, finally lowering his voice. “Either to help me sleep or keep me awake if I’ve been up all night. I dare you to name a single doctor who never took any of his own drugs!” He’d stabbed at her with his finger to make his point.

Having taken an occasional Valium herself, Cassi was not about to contradict Thomas. Besides, intuition told her to be quiet and let Thomas vent his anger.

In a more controlled tone Thomas asked her why in God’s name had she gone to Patricia. Cassi, of all people, knew how much his mother nagged him without anyone giving her such a potentially frightening subject.

Sensing that Thomas had yelled himself out, Cassi tried to explain. She said that having found the Dexedrine, she’d been scared and had mistakenly thought that Patricia would be the best person to help if Thomas did have a problem. “And I never said you were an addict.”

“My mother said you did,” snapped Thomas. “Who am I to believe?” He threw up his arms in disgust.

Cassi didn’t answer although she was tempted to say that if Thomas didn’t know the answer after forty-two years of living with Patricia, he was never going to. Instead, Cassi apologized for jumping to conclusions after finding the Dexedrine and worse still for going to his mother. Tearfully she told him how much she loved him, silently acknowledging the fact she was more terrified of Thomas’s leaving her than she was of his possible drug abuse. She wanted their relationship to return to normal. If the strain had started with her complaining about her diabetes, Cassi decided she would shield Thomas from any knowledge of her problems. But now her eye was forcing the issue. The arrival of another screaming ambulance brought Cassi to the present. As much as she did not want to upset Thomas, she knew she had no choice. She could not go into the hospital and have an operation without telling him even if she somehow found the courage to do so. With terrible foreboding Cassi pushed the elevator button. She’d see Thomas now. Knowing herself, she was afraid that if she waited until they were at home that evening, she would not be able to broach the issue.

Trying not to think anymore lest she change her mind, Cassi made her way down to Thomas’s office and pushed open the door. Fortunately there were no patients in the waiting room. Doris looked up from her typewriter and, as usual, turned back to her work without so much as acknowledging Cassi’s presence.

“Is Thomas in?” asked Cassi.

“Yes,” said Doris without interrupting her typing. “He’s with his last patient.”

Cassi sat on the rose-colored couch. She couldn’t read because the blurring effect of the drops in her eye had not yet worn off. Since Doris didn’t look at Cassi, Cassi did not feel uncomfortable watching her. She noticed that the nurse had changed her hairstyle. Cassi thought that Doris looked better without the severity of her usual bun.

Presently a patient emerged from the interior of the office. Brimming with good cheer, he smiled at Doris. “I feel terrific,” he said. “The doctor told me that I’m completely better. I can do whatever I like.”

Pulling on his coat, he said to Cassi, “Dr. Kingsley’s the greatest. Don’t worry about a thing, young lady.” Turning to Doris he thanked her, blew her a kiss, and left.

Cassi sighed as she got up. She knew Thomas was a great doctor. She wished she could elicit the kind of compassion that she believed he gave to his patients.

Thomas was dictating when Cassi stepped into his office. “Thank you again, comma, Michael, comma, for this interesting case, comma, and if I can be of any further assistance in his management, comma, do not hesitate to call. Period. Sincerely yours, end dictation.”

Clicking off the machine, Thomas swung around in his chair. He regarded Cassi with calculated indifference.

“And to what do I owe the pleasure of this visit?” he asked.

“I’ve just come from the ophthalmologist,” said Cassi, trying to control her voice.

“That’s nice,” said Thomas.

“I have to talk to you.”

“It had better be short,” said Thomas, glancing at his watch. “I’ve got a patient in cardiogenic shock that I’ve got to see.”

Cassi could feel her courage falter. She needed some sign that Thomas would not become irritated if she once again brought up her illness. But Thomas’s posture just suggested an aggressive nonchalance. It was as if he were daring her to cross some arbitrary line.

“Well?” asked Thomas.

“He had to dilate my pupils,” said Cassi, skirting the issue. “There’s been some deterioration. I wondered if we could go home a little earlier.”

“I’m afraid not,” said Thomas, standing up. “I’m pretty sure the patient I’m seeing will need emergency surgery.” He slipped off his white jacket and hung it on the hook on the door leading to the examining room. “In fact, I may have to spend the night here in the hospital.”

He said nothing about her eye. Cassi knew she had to bring up her own surgery, but she couldn’t. Instead she said, “You spent last night in the hospital. Thomas, you’re pushing yourself too hard. You need more rest.”

“Some of us have to work,” said Thomas. “We can’t all be in psychiatry.” He pulled on his suit jacket, then stepped back to the desk to snap the tape out of the dictating machine.

“I don’t know whether I can drive with this blurry eye,” said Cassi. She knew better than to respond to Thomas’s pejorative implication about psychiatry.

“You have two choices,” said Thomas. “Hang around until the drops wear off or stay the night in the hospital. Whatever you think is best for you.” Thomas started for the door.

“Wait,” called Cassi, her mouth dry. “I have to talk to you. Do you think I should have a vitrectomy?”

There, it was out. Cassi looked down and saw she was wringing her hands. Self-consciously she pulled them apart, then didn’t know what to do with them.

“I’m surprised you still care about my opinion,” snapped Thomas. His slight smile had vanished. “Unfortunately, I’m not an eye surgeon. I don’t have the slightest idea of whether you should have a vitrectomy. That’s why I sent you to Obermeyer.”

Cassi could feel his rising anger. It was just as she feared. Telling him about her eye condition was only going to make matters worse.

“Besides,” said Thomas. “Isn’t there a better time to talk about this kind of thing? I’ve got someone dying upstairs. You’ve had this problem with your eye for months. Now you show up when I’m in the middle of an emergency and want to discuss it. My God, Cassi. Think about other people once in a while, will you?”

Thomas stalked over to the door, wrenched it open, and was gone.

In a lot of ways Thomas was right, thought Cassi. Bringing up the problem of her eye in Thomas’s office was inappropriate. She knew when he said he had a patient “dying upstairs,” he meant it.

Her jaw clenched, Cassi walked out of the office. Doris made a show of typing, but Cassi guessed she’d been listening. Walking down to the elevators, Cassi decided to go back to Clarkson Two. It would keep her from thinking too much. Besides, she knew she couldn’t drive, at least not for a while.

She got back to the ward while the afternoon team meeting was still in progress.

Cassi had arranged to take the rest of the day off and did not feel up to joining the group. She was afraid if she were among friends her delicate control would crumble and she’d burst into tears.

Thankful for the unexpected opportunity of reaching her office unobserved, she slipped inside and quickly closed the door behind her. Stepping around the metal and Formica desk, which practically spanned the width of the room, she settled herself into the aged swivel desk chair. Cassi had tried to liven the cubbyhole with several bright prints of Impressionist paintings she bought at the Harvard co-op. The effort hadn’t helped much. With its harsh overhead fluorescent lighting, the room still looked like an interrogation cell.

Resting her head in her hands, she tried to think, but all she could concentrate on were her problems with Thomas. She was almost relieved when there was a sharp knock on the door. Before she could answer it, William Bentworth stepped inside.

“Mind if I sit down, Dr. Cassidy?” asked Bentworth with uncharacteristic politeness.

“No,” said Cassi, surprised to see the colonel entering her office on his own accord. He was carefully dressed in tan slacks and a freshly pressed plaid shirt. His shoes evidenced a spit-and-polish shine.

He smiled. “Mind if I smoke?”

“No,” said Cassi. She did mind, but it was one of those sacrifices she felt she had to make. Some people needed all the help they could get in order to open up and talk. On occasion the process of lighting a cigarette was an important crutch. Bentworth leaned back and smiled. For the first time his brilliant blue eyes seemed cordial and warm. He was a handsome man, with broad shoulders, thick dark hair, and angular, aristocratic features.

“Are you all right, Doctor?” asked Bentworth, leaning forward again to examine Cassi’s face.

“I’m perfectly fine. Why do you ask?”

“You look a bit distraught.”

Cassi looked up at the Monet print of the little girl and her mother in the poppy field. She tried to collect her thoughts. It frightened her a little to realize that a patient could be so perceptive.

“Perhaps you feel guilty,” offered Bentworth, considerately blowing smoke away from Cassi.

“And why should I feel guilty?”

“Because I think you have been deliberately avoiding me.”

Cassi remembered Jacob’s comment about borderline personalities being inconsistent, and she contrasted Bentworth’s current behavior with his previous refusal to talk to her.

“And I know why you’ve been avoiding me,” continued Bentworth. “I think I scare you. I’m sorry if that’s the case. Having been in the army so long and being accustomed to giving orders, I suppose I can be overbearing at times.”

For the first time in Cassi’s short psychiatric career, something that she’d read in the literature was occurring spontaneously between herself and one of her patients. She knew, without any doubt, that Bentworth was trying to manipulate her.

“Mr. Bentworth…” began Cassi.

“Colonel Bentworth,” corrected William with a smile. “If I call you Doctor, it’s only reasonable you call me Colonel. It’s a sign of mutual respect.”

“Fair enough,” said Cassi. “The fact of the matter is that you have been the one who has made it impossible for us to have a session together. I’ve tried, if you can remember, on numerous occasions to schedule a meeting, but you have always professed to have a prior commitment. Now I understand that you get more out of the group milieu than private conversation, so I haven’t pushed the situation. If you’d like to meet, let’s schedule it.”

“I would love to talk with you,” said Bentworth. “How about right now? I have the time. Do you?”

Cassi was not willing to fall prey to Bentworth’s manipulation, thinking that it would ultimately have a negative effect on their relationship. She wasn’t prepared now and Bentworth did frighten her despite his newly found charm.

“How about tomorrow morning?” said Cassi. “Right after team meeting.”

Colonel Bentworth stood up and stubbed out his cigarette in the ashtray on Cassi’s desk. “All right. I’ll look forward to it. And I hope whatever is troubling you works out for the best.”

After he was gone, Cassi breathed the smoky air while her mind envisioned Colonel Bentworth in a dress uniform. She could imagine he would be gallant and dashing, and his mental problems would seem fictitious. Knowing the depth of his disorder, she found the fact that it could be so easily camouflaged disturbing.

Before she could even dictate her notes, her door opened again, and Maureen Kavenaugh came in and sat down. Maureen had been admitted a month previously for recurrent major depression. She’d had a serious setback when her husband had come in and slapped her around. Seeing her out of her room was as much a surprise as having William Bentworth voluntarily pay a visit. Cassi wondered if some miracle drug were being secretly added to the patients’ food.

“I saw the colonel go into your office,” said Maureen. “I thought you said you weren’t going to be here this afternoon.” Her voice was flat and emotionless.

“I hadn’t planned on it,” said Cassi.

“Well, since you are here, can I talk to you for a moment?” asked Maureen timidly.

“Of course,” said Cassi. She watched Maureen advance into the room, closing the door and sitting down.

“Yesterday when we talked…” Maureen hesitated and her eyes filled with tears.

Cassi pushed the box of tissues toward the woman.

“You… you asked me if I’d like to see my sister.” Maureen’s voice was so low that Cassi could barely hear. She nodded quickly, wondering what Maureen was thinking. The woman had not shown much interest in anything since her relapse even though Cassi had started her on Elavil. At team meeting several people had suggested electric shock, but Cassi had argued against it, thinking the Elavil and supportive sessions would be adequate. What amazed Cassi was Maureen’s insight into the dynamics of her condition. But for Maureen an understanding of her illness did not automatically give her the power to influence it.

Maureen acknowledged her hostility to her mother, who had abandoned both Maureen and her younger sister when they were toddlers, and the repressed jealousy she felt toward that pretty younger sister who had run off and married, leaving Maureen to live by herself. Out of desperation she’d married an inappropriate man.

“Do you think my sister would want to see me?” asked Maureen finally, her face wet with tears.

“I think she might,” said Cassi. “But we won’t know unless you ask her.”

Maureen blew her nose. Her hair was stringy and in need of a wash. Her face was drawn, and, despite her medication, she’d continued to lose weight.

“I’m afraid to ask her,” admitted Maureen. “I don’t think she’ll come. Why should she? I’m not worth it. It’s hopeless.”

“Just thinking about talking to your sister is a hopeful sign,” Cassi said gently.

Maureen let out a long sigh. “I can’t make up my mind. If I call her and ask her and she says no, then everything will be worse. I want someone else to do it. Would you call her?”

Cassi flushed. She thought of her own indecisiveness in facing Thomas. Maureen’s feelings of dependency and helplessness seemed all too familiar. She too wanted someone else to make her decisions. With exhausting effort, Cassi tried to concentrate on the woman sitting across from her.

“I’m not sure it’s my place to contact your sister,” said Cassi. “But it’s something we can talk about. As far as seeing your sister, I think that is a good idea. Why don’t we talk about it more tomorrow? I think you’re scheduled for a session at two.”

Maureen agreed and, after taking several more tissues, went out, leaving the door open.

Cassi sat for some time, staring blankly at the wall. She felt certain that identifying with one of her patients was a sign of her inexperience.

“Hey! How come you aren’t in team meeting?” said Joan Widiker, doing a double take in the corridor after catching a glimpse of Cassi.

Cassi glanced up but didn’t answer.

“What’s going on?” asked Joan. “You look a little worse for wear.” She stepped into Cassi’s office and sniffed. “And I didn’t know you smoked.”

“I don’t,” said Cassi. “Colonel Bentworth does.”

“He came to see you?” Joan raised her eyebrow. “You’re doing better than you think.” She paused and then sat down.

“I thought I’d let you know that Jerry Donovan and I went out. Have you talked with him?”

Cassi shook her head.

“It didn’t work out too well. All he wanted…” Joan stopped in midsentence. “Cassi, what’s the matter with you?”

Tears overflowed Cassi’s eyes and ran down her cheeks.

As she had feared, a friendly presence destroyed her self-control. She finally let go and, dropping her face into her hands, wept openly.

“Jerry Donovan wasn’t that bad,” said Joan, hoping a little humor might help. “Besides, I didn’t give in. I’m still a virgin.”

Cassi’s body shook with sobs. Joan came around the end of the desk and put her arm around her friend’s shoulder. For a few moments she said nothing. As a psychiatry resident, she didn’t have the usual negative reaction to tears that lay people did. From the strength of Cassi’s emotion Joan guessed that she needed the outlet.

“I’m sorry,” said Cassi, reaching for the tissues just as Maureen had. “I didn’t want to do this.”

“Sounds like you needed it. Do you want to talk?”

Cassi took a deep breath. “I don’t know. It all seems so hopeless.” As soon as she said the word, Cassi remembered Maureen had said the same thing.

“What’s so hopeless?” asked Joan.

“Everything,” said Cassi.

“Give me an example,” said Joan, challengingly.

Cassi pulled her hands away from her tear-streaked face.

“I went to the ophthalmologist today. He wants to operate, but I don’t know if I should.”

“What does your husband say?” asked Joan.

“That’s part of the problem.” As soon as Cassi spoke, she regretted it. She knew Joan, being both sensitive and clever, would piece together the whole picture, and, in the back of her mind, Cassi could hear Thomas telling her not to discuss her medical problems with anyone.

Joan took her hand from Cassi’s shoulder. “I think you need someone to talk to. As the official department consult, I’m at your service. Besides, anyone can afford my fee.”

Cassi managed a weak smile. Intuitively she knew she could trust Joan. She needed someone’s insight, and God knows she wasn’t doing too well on her own.

“I don’t know if you have any idea of Thomas’s schedule,” began Cassi. “He works harder than anyone I know. You’d think he was an intern. Last night he stayed in the hospital. Tonight he’ll stay in the hospital. He doesn’t have a lot of extra time…”

“Cassi,” said Joan politely. “I don’t like to interrupt but why not save the excuses. Have you spoken to your husband about this operation?”

Cassi sighed. “I tried to bring it up a few hours ago, but it was the wrong time and place.”

“Listen,” said Joan. “I rarely make judgments. But when it comes to talking about eye surgery with your husband, there is no wrong time or place.”

Cassi digested this comment. She wasn’t sure if she agreed or not.

“What did he say?” asked Joan.

“He said he wasn’t an eye surgeon.”

“Ah, he wants to delegate his responsibility.”

“No,” said Cassi emphatically. “Thomas made sure I went to the best ophthalmologist.”

“It still seems a rather callous reaction.”

Cassi looked down at her hands, thinking Joan was too clever. She had the distinct impression that Joan could take this conversation further than Cassi would like.

“Cassi,” asked Joan, “is everything all right between you and Thomas?”

Cassi could feel the tears filling her eyes again. She tried to stop them but was only partially successful.

“That’s one way of answering,” said Joan empathetically. “Do you want to talk about it?”

Cassi bit her trembling lower lip. “If something happened to my relationship with Thomas,” she said, “I don’t know if I could go on. I think my life would fall apart. I need him desperately.”

“I can sense you feel that way. I also think that you don’t really want to talk about the problem. Am I right?”

Cassi nodded. She felt torn between her fear of Thomas and her guilt at rejecting Joan’s offer of friendship.

“Okay,” said Joan, “but before I go, I think some advice is in order. Maybe it’s presumptuous for me to say this, and it’s certainly not professional, but I have a feeling that you should try to lessen your dependency on Thomas. Somehow I don’t think you give yourself the credit you deserve. And that kind of dependence can really hurt a relationship in the long run. Well, enough unsolicited advice.”

Joan opened Cassi’s door, then stopped. “Did you say that Thomas was going to spend tonight in the hospital?”

“I think he has emergency surgery,” said Cassi, preoccupied with the concept of dependency. “When he does, he usually sleeps over rather than suffer the forty-minute commute.”

“Fine!” said Joan. “Why don’t you come home with me tonight? I’ve got a sofa bed in the living room and a fully stocked refrigerator.”

“And by midnight you’d know all my secrets,” said Cassi, only half in jest.

“I’d be on my honor not to probe,” said Joan.

“Anyway, I can’t,” said Cassi. “I appreciate the offer, but there’s always the chance Thomas might not have surgery and, in that case, he could come home. Under the circumstances I want to be there. Maybe we’ll talk.”

Joan smiled sympathetically. “You do have it bad. Well, if you change your mind, give me a call. I’ll be in the hospital for another hour or so.” She opened the door again and this time really left.

Cassi stared at the Monet trying to decide if it was safe for her to drive. It was reassuring to note that her vision had significantly improved; the drops were finally wearing off.

Thomas felt his hands tremble as he opened his office door and switched on the light. The clock on Doris’s desk indicated that it was almost six-thirty. It was already dark outside, making it hard to remember summer nights when it stayed light to nine-thirty. Closing the door, he held out his arm. It scared him to see his normally steady hand shake so violently. How could Cassi keep pressuring him when he was already so tense?

Approaching his desk, he opened the second drawer and pulled out one of his small plastic bottles. The combination of the child-proof top and his agitation made opening the package impossible. He had to restrain himself from dashing the thing on the floor and stomping on it with his heel. Finally he managed to extract one of the yellow tablets. He placed it on his tongue despite its bitter taste and walked into the small washroom, which still reeked of Doris’s perfume.

Forsaking a cup, Thomas bent and drank directly from the faucet. He went back to his office and sat at his desk. His anxiety seemed to be increasing. Wrenching open the second drawer again, he fumbled for the same plastic bottle. This time he was unsuccessful with the top. Slamming the bottle down on the desk top only succeeded in denting the wood surface and bruising his thumb.

Closing his eyes, Thomas told himself that he had to stay in control. When he opened his eyes, he remembered that in order to open the bottle he had to line up the two arrows.

But he did not take another pill. Instead his mind conjured up the image of Laura Campbell. There was no reason for him to be alone. “I wish there was something I could do for you,” she had said. “Anything!” Thomas knew he had her phone number in her father’s folder, ostensibly for emergency use. But wasn’t this an emergency? Thomas smiled. Besides, there were many ways to camouflage his intentions if he’d misread her signals.

Thomas found Mr. Campbell’s folder and quickly dialed Laura’s number, hoping the woman was at home. She answered on the second ring.

“This is Dr. Kingsley. Sorry to bother you.”

“Is something wrong?” asked Laura worriedly.

“No, no,” assured Thomas. “Your father is doing fine. I’m terribly sorry about his jaundice. It is one of those unfortunate complications. I wish we could have anticipated it, but it should clear soon. Anyway the reason I’m calling is that your father will undoubtedly be discharged soon, and I thought, perhaps, you’d like to discuss the case.”

“Absolutely,” said Laura. “Just tell me when.”

Thomas twisted the phone cord. “Well, that’s why I’m calling. I’m sure you can guess what my schedule is like. But it so happens I’m waiting for a surgery and am presently alone in my office. I thought, perhaps, you might consider coming over.”

“Can you give me thirty minutes?” asked Laura.

“I think so,” said Thomas. He knew he had plenty of time.

“I’ll be there,” said Laura.

“One other thing,” added Thomas. “To get into the Professional Building at this hour you must go through the hospital. The doors here are locked at six.”

Thomas hung up. He felt much better. Excitement had replaced anxiety. Opening the desk drawer, he dropped in the container of pills. Then he called the cardiac catheterization lab to check on the patient in cardiogenic shock. As he had expected, the patient was still awaiting catheterization. No matter what the procedure showed, Thomas guessed he had several hours.

Thomas met Laura at the door to the inner office and motioned her inside. He was pleased to see that again she was wearing a thin, clinging silk dress. It was a light beige, almost the color of her skin. Thomas could see the faint line of her panties.

He didn’t speak for a moment, plotting his opening so that if he’d misread her signals there wouldn’t be any embarrassment. He began by reassuring her once again that her father would soon be discharged. Then he discussed Mr. Campbell’s long-term care, and under the pretense of discussing his exercise limitations, Thomas brought up the issue of sex.

“Your father had asked me about this before the operation,” he said, watching Laura’s face. “I know that your mother passed away several years ago, and if this is an uncomfortable subject for you…”

“Not at all,” said Laura with a smile. “I am an adult.”

“Of course,” said Thomas, letting his eyes run over her dress. “That is very obvious.”

Laura smiled again and smoothed her long ponytail off her shoulder.

“A man like your father still has sexual needs,” said Thomas.

“As a physician I’m sure you know that better than most,” said Laura. She’d uncrossed her legs and leaned forward. It was clear she wasn’t wearing a bra under the sheer silk.

Thomas got up from his chair and came around in front of the desk. He was certain Laura hadn’t come to talk about her father. “I understand these needs all too well myself because I have a wife with a chronic, debilitating disease.”

Laura smiled. “As I said, I wish there was something I could do for you.” She stood up and leaned against Thomas. “Can you think of anything?”

Thomas led her into the dimly lit examining room. Slowly he helped her out of her dress and then stepped out of his own clothes, folding them neatly on a chair. When he turned back to face her, he was pleased to find himself fully erect.

“What do you think?” he asked, with his palms spread out to the sides.

“I love it,” said Laura huskily, reaching out for him.

After having worried about driving, Cassi was glad that her trip home was pleasantly uneventful. The most hazardous part had been the walk from the garage to the house. She’d forgotten how early night came now that it was December.

The house itself was ominously black, particularly the windows, which shone like pieces of polished onyx. Inside Cassi found a note from Harriet explaining how to heat up dinner. Whenever Harriet got the word that Thomas was not coming home, she left early. As contrary as Harriet could be, Cassi would have preferred not to be alone.

She went through the house snapping on lights hoping to make the place a bit more cheerful. She found the rambling old house with its cavernous spaces particularly chilling, her footsteps echoing down the empty halls. The heat was supposed to be turned to sixty-five degrees, but Cassi could see her breath.

Upstairs the morning room was considerably warmer, almost comfortable. In the master bath she had a supplementary quartz heater, which she turned on. After testing her blood sugar, Cassi went ahead with her usual insulin dose, then took a shower.

She tried not to think too much. Her emotional outburst had left her drained and had settled nothing. She knew Joan was right about her dependency, and it reminded Cassi of the identification she’d felt with Maureen Kavenaugh. Just like her patient, Cassi felt hopeless, timid, and fearful. She wondered if she too lacked the ability to influence her life even when she understood her problem. Then in a flash of sudden horror, Cassi became aware of the power of her denial. One of the reasons she’d suspected that Thomas was abusing drugs was because of his pupils. So often of late they had been mere pinpoints, but Dexedrine caused dilated pupils! Other drugs caused small pupils. Other drugs that Cassi did not want to think about.

Cassi could feel perspiration appear on her palms. She did not know if it was from sudden terror or from her insulin. Praying that her fears were groundless, she forced herself down the hall to Thomas’s study.

Flipping on the light, she stood there, her eyes recording all the details of the room. Against her will, she recalled the consequences of her previous visit, and she fought against the urge to flee.

The medicine cabinet in the bathroom was exactly as it had been two weeks earlier: a mess. It contained nothing that was suspicious. Getting down on her hands and knees, Cassi searched beneath the sink. Nothing. Then she went through the towel cabinets. Again nothing.

Feeling a modicum of relief, Cassi went back to the study itself. Besides the desk and burgundy reading chair, there was the sofa bed, bordered by two end tables with lamps, a hassock, an entire wall of bookshelves, a liquor cabinet, and an antique highboy with claw feet. The floor was covered with an enormous Tabriz carpet.

Cassi walked over to the desk. It was an imposing piece of furniture, which she knew had belonged to Thomas’s grandfather. As she reached out and touched the cool surface, she had the same naughty sensation she’d felt as a child, snooping in her parents’ bedroom. Shrugging her shoulders, she pulled out the center drawer. A plastic desk organizer was filled to overflowing with rubber bands, paper clips, and other odds and ends. She pulled the drawer out to its limit and carefully lifted the layers of papers toward the back. Nothing out of the ordinary. Satisfied, Cassi was about to push it closed when she thought she heard a door slam. Peering through the window, she could see the lights in Patricia’s apartment over the garage. She hadn’t heard a car, but that wasn’t too surprising. With the storm windows down, sounds from the outside did not penetrate the house too easily. She could see the garage door was closed. Had she closed it? She couldn’t remember. A moment later there were footsteps in the hall. Panic knotted her stomach. Obviously Thomas had come home. If he caught her in his study after the episode with Patricia, he’d be furious. She looked around frantically, wondering if she could slip out through the spare room. But before she could move, the door opened.

It was Patricia. She was as surprised to find Cassi as Cassi her. The two women stared at each other in disbelief.

“What are you doing in here?” Patricia said finally.

“I was about to ask you the same question,” returned Cassi, standing behind the desk.

“I saw the light go on in here. Naturally, I thought Thomas had come home after all. As his mother I think I’m entitled to see him.”

Cassi unconsciously nodded as if she agreed. Actually it had been a constant source of irritation for her that Patricia had a key to the house and felt no compunction about entering whenever she wanted.

“That’s my excuse,” said Patricia. “What’s yours?”

Cassi knew she should have simply replied that it was her home and she could go into any room she pleased. But she didn’t. Her sense of guilt made it impossible.

“I suppose I can guess,” said Patricia disdainfully, “even though it upsets me. Snooping through his possessions like this when he’s in the hospital saving lives! What kind of a wife are you?”

Patricia’s question hung in the air like static electricity. Cassi didn’t try to answer. She’d begun to wonder herself what kind of a wife she was.

“I think you should leave this room at once,” rasped Patricia.

Cassi didn’t object. She walked past her mother-in-law with her head bowed. Patricia followed her out and closed the door. Without looking back, Cassi descended the stairs and headed for the kitchen. She heard the front door close and presumed Patricia had left. The woman would tell Thomas that Cassi had been in his study. It was inevitable.

She looked at the meal Harriet had left on the stove with distaste, but she knew that after taking her normal insulin dose she required a certain amount of calories. Forcing down the warmed-over food, she made up her mind to return to the study and finish her search. Having already been caught, she no longer had anything to fear except what she’d find.

There was still the chance Thomas could appear, but Cassi was prepared to listen for the sounds of the Porsche. In order to keep from having to face Patricia again, Cassi pulled the heavy drapes over the windows, and she used a flashlight, like a real burglar. She went directly to the desk and tried the side drawers, starting at the top and working her way down. She didn’t have far to go. In the back of the second drawer inside a stationery box, Cassi found a collection of plastic pill containers. Some were empty, but most were full. All of them had the same prescribing M.D., a Dr. Allan Baxter. The dates were all within the past three months.

In addition to the Dexedrine, there were two other types of pills, and Cassi carefully took one of each. She replaced the vials in the stationery box and closed the drawer. Switching off the flashlight, she reopened the curtains and walked quickly back to her room. When she got out her Physician’s Desk Reference and compared the pills to the identification pictures, she realized that her suspicions were right. “Oh God!” she said out loud. “Dexedrine for exhaustion is one thing. Percodan and Talwin are something else entirely.”

For the second time that day Cassi burst into tears. This time she did not even try to check her sobs. She flung herself down on the bed and wept uncontrollably.

Despite his interlude with Laura, Thomas decided to keep his planned visit with Doris. He was disappointed enough that the man in cardiac cath had suffered a second heart attack and couldn’t be scheduled for surgery. He certainly wasn’t going to ruin the night further by the long drive home.

Doris buzzed him in the minute he touched the bell. When he reached the second floor, he found her peering coyly around the door. When she opened it, he realized why she’d stayed inside. She was dressed in a diaphanous, short black camisole that laced up the front and snapped between her legs. It covered about the same area as a one-piece bathing suit.

“Glenlivet with Perrier,” said Doris, handing Thomas a tumbler and pressing herself up against him before he could get his coat off.

Thomas took the drink in one hand and put the other on Doris’s backside. The only light in the room came from a Scandinavian-style oil lamp that painted the room with warm, golden tones. The coffee table was also laid for dinner with an uncorked bottle of wine standing nearby.

When Doris retreated to the kitchen, Thomas called the hospital page operator. He gave her Doris’s number along with the admonition it was for the thoracic resident-on-call only. She was not to give it to anyone else, and if there were a question she should call herself.