Godplayer

Seven

Cassi’s eyes blinked open. It was a little after five in the morning and was not yet light outside. The alarm wasn’t scheduled to go off for another two hours.

For a while she lay still, listening. She thought perhaps some sound had awakened her but as the minutes passed, she realized that the disturbance had come from within her head. It was the classical symptom of depression.

At first Cassi tried turning over and drawing the covers up over her head, but she soon recognized it was useless. She couldn’t go back to sleep. She got out of bed, knowing full well that she would be exhausted that day, especially since Thomas had made her accept an invitation to go to the Ballantines that evening.

The house was frigid, and she was shivering before she got on her bathrobe. In the bathroom she turned on the quartz heater and started the shower.

Stepping under the water, Cassi reluctantly allowed herself to remember the reason for her depression-the discovery of the Percodan and the Talwin in Thomas’s desk. And Patricia was undoubtedly going to inform her son that Cassi had again been snooping in his study. Thomas would guess that she’d been looking for drugs.

Getting out of the shower, Cassi tried to decide what to do. Should she admit she’d found the drugs and confront him? Was the presence of the drugs sufficiently incriminating? Could there be another explanation for their presence in Thomas’s desk? Cassi doubted it, considering the additional fact of Thomas’s frequently pinpointed pupils. As much as Cassi did not want to believe it, Thomas was most likely taking the Percodan and Talwin. How much, Cassi had no idea. Nor did she have any idea how much she was to blame.

The thought occurred to Cassi that maybe she should seek help. But who to turn to? She had no idea. Patricia obviously wasn’t the answer, and if she went to any of the authorities, then Thomas’s career could be ruined. Cassi felt almost too depressed to cry. It was a no-win situation. No matter what she did or didn’t do, it was going to cause trouble. Lots of trouble. Cassi was aware that her relationship with Thomas could very well be at stake.

It took all her strength to finish getting ready for work and make the long drive to the hospital.

Cassi had no more than dumped her canvas bag on her desk when Joan’s head came through the door.

“Feeling any better?” asked Joan brightly.

“No,” said Cassi in a tired, flat voice.

Joan could sense her friend’s depression. From a professional point of view she knew Cassi was worse than she’d been the previous afternoon. Unbidden, Joan came into Cassi’s office and closed the door. Cassi didn’t have the energy to object.

“You know the old aphorism about the sick doctor,” said Joan: “ ‘He who insists on taking care of himself learns he has a fool for a patient.’ Well, that applies in the emotional realm as well. You don’t sound so good to me. I came in here to apologize for foisting my opinions on you yesterday, but looking at you now, I think it was the right thing to do. Cassi, what’s happening to you?”

Cassi was immobilized.

There was a knock on the door.

Joan opened it and confronted a tearful Maureen Kavenaugh.

“Sorry, Dr. Cassidy is occupied,” said Joan. She closed the door in Maureen’s face before the woman could respond.

“Sit down, Cassi,” said Joan firmly.

Cassi sat down. The idea of forceful direction was appealing.

“Okay,” said Joan. “Let’s hear what’s going on. I know you have your hands full with your eye problem. But it’s more than that.”

Once again Cassi recognized the seductive pressure of the psychiatric interview on the patient to talk. Joan inspired confidence. There was no doubt about that. And Cassi could be assured of confidentiality. And in the last analysis Cassi desperately wanted to share her burden with someone. She needed some insight if not merely support.

“I think Thomas is taking drugs,” said Cassi in a voice so low Joan could barely hear. She watched Joan’s face for the expected signs of shock, but there weren’t any. Joan’s expression didn’t change.

“What kind of drugs?” asked Joan.

“Dexedrine, Percodan, and Talwin are the ones I know of.”

“Talwin is very common among physicians,” said Joan. “How much is he taking?”

“I don’t know. As far as I am aware, his surgery hasn’t suffered in the slightest. He’s working as hard as ever.”

“Uh huh,” nodded Joan. “Does Thomas know you know?”

“He knows I suspect the Dexedrine. Not the others. At least not yet.” Cassi wondered how soon Patricia would tell Thomas she’d been in his study.

“There’s a euphemistic term for this,” said Joan. “It’s called the ‘impaired physician.’ Unfortunately it is not all that uncommon. Maybe you should read up on it; there’s a lot of material in the medical literature although doctors themselves usually hate to confront the problem. I’ll give you some reprints. But tell me, has Thomas exhibited any of the associated behavioral changes-like embarrassing social behavior or disruption of his appointment schedule?”

“No,” said Cassi. “As I said before, Thomas is working harder than ever. But he did admit that he is getting less enjoyment from his work. And he seems to have less tolerance lately.”

“Tolerance for what?”

“For anything. For people, for me. Even his mother, who essentially lives with us.”

Joan rolled her eyes. She couldn’t help it.

“It’s not that bad,” said Cassi.

“I’ll bet,” said Joan cynically.

The two women studied each other in silence for a few minutes.

Then Joan asked tentatively, “What about your married life?”

“What do you mean?” asked Cassi evasively.

Joan cleared her throat. “Often physicians abusing drugs will suffer episodes of impotence and actively seek extramarital affairs.”

“Thomas has no time for extramarital affairs,” said Cassi without hesitation.

Joan nodded, beginning to think that Thomas did not sound very “impaired.”

“You know,” said Joan, “your comment about Thomas’s low frustration level and the fact that he’s getting less enjoyment from his work these days is suggestive. Many surgeons are slightly narcissistic and share some of the side effects of the disorder.”

Cassi didn’t respond, but the concept made sense.

“Well, it’s food for thought,” said Joan. “It’s an interesting idea that Thomas’s success could be a problem. Narcissistic men need the kind of structure and constant feedback you get in a competitive surgical residency.”

“Thomas did remark that there was no longer anyone for him to compete with,” said Cassi, catching Joan’s train of thought.

Just then Cassi’s phone rang. As Joan watched her friend pick up the receiver, she was pleased. Cassi was already acting less depressed. In fact, she managed a smile when she realized it was Robert Seibert.

Cassi kept the conversation brief. After she hung up, she told Joan that Robert was in seventh heaven because he got another SSD case.

“That’s wonderful,” said Joan sarcastically. “If you’re about to invite me to the autopsy, thanks but no thanks.”

Cassi laughed. “No, in fact I declined myself. I’ve scheduled patients all morning, but I told Robert I’d come up at lunch to go over the results.” Talking about time made Cassi glance at her watch. “Uh oh! I’m late for team meeting.”

The meeting went well. There’d been no catastrophes overnight nor any new admissions. In fact, the resident on call was pleased to report that he’d gotten nine hours of undisturbed sleep, which made everybody extremely jealous. Cassi got a chance to discuss Maureen’s sister, and the consensus was that Cassi should encourage Maureen to contact her herself. There was general agreement that it was worth the risks to bring the sister into the treatment process if possible.

Cassi also described Colonel Bentworth’s apparent improvement as well as his attempts to manipulate her. Jacob Levine found this particularly interesting but warned Cassi about jumping to premature conclusions.

“Remember, borderlines can be unpredictable,” said Jacob, taking off his glasses and pointing them at Cassi for emphasis.

The meeting broke up early since there were no new admissions nor new problems. Cassi declined an offer of coffee, as she did not want to be late for Colonel Bentworth. When she got back to her office, he was waiting by the door.

“Good morning,” said Cassi as brightly as she could, opening her office door and entering.

The colonel was silent as he followed Cassi in and sat down. She self-consciously took her place behind the desk. Cassi didn’t know why, but the colonel exacerbated her professional insecurities, especially when he stared at her with those penetratingly blue eyes which she finally realized reminded her of Thomas’s. They were both the same startling turquoise.

Bentworth again did not look like a patient. He was impeccably dressed and seemed to have totally regained his air of command. The only visible hint he was the same person Cassi had admitted several weeks earlier were the healing burns on his forearm.

“I don’t know how to begin,” said Bentworth.

“Maybe you could start by telling me why you’ve changed your mind about seeing me. Up until now you’ve refused private sessions.”

“Do you want it straight?”

“That’s always the best way,” said Cassi.

“Well, to tell the truth, I want a weekend pass.”

“But that kind of decision is usually made by the group.”

Group was Bentworth’s major therapeutic agent at the moment.

“That’s true,” said the colonel, “but the goddamn ignorant sons of bitches wouldn’t let me go. You could overrule them. I know that.”

“And why would I want to overrule the people who know you the best?”

“They don’t know me,” shouted Bentworth, slapping his hand on the desk.

The sudden movement frightened Cassi, but she said quietly, “That kind of behavior is not going to get you anywhere.”

“Jesus Christ!” said Bentworth. He got up and paced the small room. When Cassi didn’t react, he threw himself back into his chair. Cassi could see a small vein throbbing in his temple.

“Sometimes I think it would be easier just to give up,” said Bentworth.

“Why didn’t the members of your group think you should have a weekend pass?” asked Cassi. The only thing she was prepared for on Bentworth’s part was manipulative behavior, and she wasn’t going to fall for it.

“I don’t know,” said the colonel.

“You must have an idea.”

“They don’t like me. Is that good enough? They’re all a bunch of jerks. Blue-collar workers, for Christ’s sake.”

“That sounds pretty hostile.”

“Yeah, well, I hate them all.”

“They happen to be people like you with problems.”

Bentworth didn’t respond immediately, and Cassi tried to remember what she’d read about treating borderline personalities. The actuality of psychiatry seemed a thousand times more difficult than the conceptualization. She knew that she was supposed to play a structuring role, but she wasn’t sure exactly what that meant in the context of the current session.

“The crazy thing is that I hate them, yet I need them.” Bentworth shook his head as if he were confounded by his own statement. “I know that sounds weird, but I don’t like to be alone. The worst thing is for me to be alone. It makes me drink, and liquor makes me go nuts. I can’t help it.”

“What happens?” asked Cassi.

“I always get propositioned. It never fails. Some dude sees me and guesses I’m a stud, so he comes over and starts to talk to me. I end up beating the guy to a pulp. It’s one thing the army taught me. How to fight with my hands.”

Cassi remembered reading that both borderline personalities and narcissists wanted to protect themselves from homosexual impulses. Homosexuality could be a potentially fertile area for future sessions, but for the moment she didn’t want to push into areas that were too sensitive.

“What about your work?” asked Cassi to change the subject.

“If you want to know the truth, I’m tired of being in the army. I liked the early competition. But now that I’m a colonel, that’s over. I’ve arrived. And I’m not going to make general because too many people envy me. There is no more challenge. Every time I go into the office I get this empty feeling-like what’s the use.”

“An empty feeling?” echoed Cassi.

“Yeah, empty. I feel the same after I’ve been living with a woman for a couple of months. At first it’s intense and exciting, but it always goes sour. It gets empty. I don’t know how else to explain it.”

Cassi bit her lip.

“The ideal relationship with a woman,” said Bentworth, “would be one month long. Then, puff, she’d disappear and another one would take her place. That would be perfect.”

“But you were married.”

“Yeah, I was married. Only lasted a year. I just about killed the broad. All she did was complain.”

“Are you living with someone now?”

“No. That’s why I’m here. The day before they picked me up, she walked out. I’d only known her for a couple of weeks, but she met some other guy and took off. That’s why I want to get out of here for the weekend. She’s still got a key to my apartment. I’m afraid she might clean me out.”

“Why not call a friend and have him change the lock?” said Cassi.

“There’s nobody I can trust,” said Bentworth, standing up. “Look, are you going to give me a weekend pass or is all this bull for nothing?”

“I’ll bring it up at the next team meeting,” said Cassi. “We’ll discuss it.”

Bentworth leaned over the desk. “The only thing I’ve learned in all my time in the hospital is that I hate psychiatrists. They think they’re so goddamned smart, but they’re not. They’re a hell of a lot crazier than I am.”

Cassi returned his stare, noticing how cold his eyes had become. The thought went thought her mind that Colonel Bentworth should be committed. Then she remembered he was.

Cassi knocked on the doorjamb of Robert’s tiny office. As he looked up from his binocular scope, his face broke into a broad and infectious smile. He jumped up so quickly to hug Cassi that his chair sped back on its wheels to the opposite wall.

“You look down,” said Robert examining her. “What’s wrong?”

Cassi looked away. She had had enough talk in the past few hours. “I’m just exhausted. I thought psychiatry was going to be so easy.”

“Then maybe you should transfer back to pathology,” said Robert as he pulled out a chair for Cassi. Leaning forward, he rested his hands on her knees. If any other man had done so, Cassi would have been annoyed, but she was comforted by Robert’s gesture.

“What can I get for you? Coffee? Orange juice? Anything?”

Cassi shook her head. “I wish you could give me a good night’s sleep. I’m beat, and I have to go to a party tonight at Doctor Ballantine’s home in Manchester.”

“Wonderful,” cooed Robert. “What are you going to wear?”

Cassi rolled her eyes in disbelief, saying she hadn’t given it a moment’s thought, at which point Robert, who had some knowledge of Cassi’s wardrobe, made several suggestions. Cassi interrupted to say that she’d come to hear about the autopsy, not for his fashion advice.

Robert made an exaggerated expression of being hurt and said, “The only thing that you come up here for is business. I can remember when we used to be friends.”

Cassi reached out to give Robert a friendly shake, but he eluded her by pushing back on his chair, which glided smoothly out of the way. They both laughed. Cassi sighed and realized she felt better than she had all day. Robert was like a tonic.

“Did your husband tell you he saved me at the last surgical death conference?”

“No,” said Cassi, surprised. She’d never mentioned Thomas’s antipathy to Robert, but it was all too obvious the few times they’d met.

“I made a big mistake. I got this crazy notion that the cardiac surgeons would be overjoyed to hear about SSD, and I decided to make a preliminary presentation at yesterday’s conference. It turned out to be the worst thing I could have done. I suppose I should have realized their egos are such that they’d consider the study a form of criticism. Anyway, when I finished talking, Ballantine started to chew me out until Thomas interrupted with an intelligent question. That sparked a few more questions, and what could have been a total disaster was averted. I did get a lot of heat this morning from the chief of pathology. It seems George Sherman had asked him to muzzle me in the future.”

Cassi was impressed and grateful for her husband’s intervention. She wondered why he hadn’t mentioned it to her until she remembered that she hadn’t given Thomas a chance. She’d brought up her eye surgery the second she’d seen him.

“Maybe I’ll have to take back some of the nasty things I’ve said about your husband,” added Robert.

There was an awkward silence. Cassi did not want to get into a discussion of her own feelings just then.

“Well,” said Robert, rubbing his hands together enthusiastically. “To work! As I said on the phone, I think I found a new SSD case.”

“Cyanotic like the last?” asked Cassi, eager to change the subject.

“Nope,” said Robert. “Come on, I want to show you.”

He leaped to his feet and dragged Cassi out of his office and into one of the autopsy rooms. A young, light-skinned black was laid out on the stainless steel table. The standard Y autopsy incision had been closed with heavy sutures and clumsy bites of tissue.

“I asked them to leave the body so you could see something,” said Robert, his voice echoing in the tiled room.

He let go of Cassi and inserted his thumb into Jeoffry Washington’s mouth, pulling down the lower jaw. “Look in here.”

With her hands behind her back, Cassi bent over and looked into the patient’s mouth. The tongue was a mangled piece of meat.

“Chewed hell out of it,” said Robert. “Obviously had one hell of a grand mal seizure.”

Cassi straightened up, a little sickened by what she’d seen. If this was an SSD case, he was the youngest yet.

“I think this one died of an arrhythmia,” said Robert, “but I won’t know for sure until the brain is fixed. You know, seeing this kind of case doesn’t help my anxiety about my own surgery.” Robert glanced over at Cassi.

“When are you going to have it?” she asked. Robert’s statement sounded definitive.

Robert smiled. “I told you, but you wouldn’t believe that I was going to get it over with. I’m being admitted tomorrow. What about yours?”

Cassi shook her head. “It’s not definite yet.”

“You chicken,” accused Robert with an air of superiority. “Why don’t you schedule yours for the day after tomorrow, too, so we can visit together in the recovery room.”

Cassi didn’t want to tell Robert about her difficulties talking the matter over with Thomas. Reluctantly her eyes went back to the corpse.

“How old?” asked Cassi, motioning toward Jeoffry Washington.

“Twenty-eight,” said Robert.

“God, that’s young,” said Cassi. “And it’s only been two weeks since the last case.”

“That’s a fact,” said Robert.

“You know, the more I think about it, the more disturbing these cases are.”

“Why do you think I’ve persisted?” said Robert.

“With the number you have now and the apparent increase in frequency, it’s getting harder and harder to ascribe the deaths to chance.”

“I agree,” said Robert. “Ever since the last, I’ve had the nagging suspicion that these deaths are more closely related than we suspect. The only trouble with that idea is that it suggests a specific agent, and as your husband pointed out, the deaths are physiologically different. The facts don’t fit the theory.”

Cassi walked around the table to Jeoffry’s right side. “Does this look swollen to you?” she said, reaching out and running her hand up the body’s forearm.

Robert bent down to look. “I don’t know. Where?”

Cassi pointed. “Was the patient on IV?”

“I think so,” said Robert. “I think he was on antibiotics for phlebitis.”

Cassi picked up Jeoffry’s left arm and looked at the IV site. It was red and puffy. “Just for interest’s sake, how about getting some sections of the vein where the IV was?”

“Anything if it will get you to come up and visit.”

Cassi replaced Jeoffry’s arm as carefully as if it were still sensate. “Do you happen to know if all the SSD cases were on IVs?” asked Cassi.

“I don’t know, but I can find out,” said Robert. “I have an idea what you’re thinking, and I don’t like it.”

“The other suggestion I have,” said Cassi, “is to collate the supposed physiological mechanisms of death and see if there is any pattern. You know what I mean.”

“I know what you mean,” said Robert. “I can probably do that today. And I’ll get the sections of the vein, but you have to promise to come up and look at them. Agreed?”

“Agreed,” said Cassi.

As Cassi pressed the elevator button in the corridor outside the pathology department, she was aware she was dreading her upcoming session with Maureen Kavenaugh. Without doubt, Maureen’s depression exacerbated Cassi’s own. The fact that Cassi had reason to be depressed, as Joan had pointed out, did not make the symptoms easier to live with.

Dreading the meeting with Maureen bothered Cassi because it forced her to admit that as a psychiatrist she was going to have to deal with her own value judgments. In other areas of medicine, if you were forced together with a patient you disliked, you concentrated on the pathology and cut the personal contact to a minimum. In psychiatry that was not possible.

Happily, when she entered her office, Maureen still was nowhere to be seen. Cassi knew she was going to have difficulty concentrating on what Maureen had to say because Robert’s decision to have his surgery brought up the issue of her own. She knew Robert was right. After a moment’s indecision, she dialed Thomas’s office.

Unfortunately, he was still in surgery.

“I don’t know when he will be out,” said Doris. “But I know it will be late because he called me and told me to cancel his afternoon office hours.”

Cassi thanked her and hung up. Blankly she stared at her Monet print. Joan’s comment about the “impaired physician” disrupting his appointment schedule flashed into her mind. Then she dismissed the thought. Thomas had obviously canceled his office hours because he was stuck in surgery.

A knock interrupted her thoughts. Maureen’s listless face appeared in the doorway.

“Come in,” said Cassi as cheerfully as she could. She suspected that the next fifty minutes were going to be a good example of the blind leading the blind.

It was Doris, not Thomas, who called Cassi in the middle of the afternoon to say that Dr. Kingsley would meet her at the front entrance to the hospital at six o’clock sharp. She insisted Cassi be on time because of the party that night. Cassi was in the lobby promptly, but when the clock over the information booth showed twenty after six, she worried that she may have gotten the message wrong.

The entrance of the hospital was crowded with waves of people coming and going. The people leaving were primarily employees, and they chattered and laughed, glad to see the workday come to an end. Those arriving were mostly visitors who seemed subdued and intimidated as they lined up in front of the information booth to get directions from the volunteers in their green smocks.

Watching the crowds made time pass, and when Cassi looked back at the clock, it was almost six-thirty. Finally she decided to call Thomas’s office, but as she moved toward the phone, she caught a glimpse of his head above the crowd. He looked as tired as Cassi felt. His face was shadowed, which turned out to be an irregular growth of beard as if he’d not shaved carefully that morning. As he came closer, Cassi could see that his eyes were red-rimmed.

Unsure of her reception, Cassi held her tongue. When she realized that Thomas had no intention of talking or even stopping, she hooked her arm in his and was carried toward the rapidly revolving door.

Outside Cassi was confronted by a mixture of rain and snow, which melted the instant the flakes touched the ground. Hefting her bag onto her shoulder, she shielded her face and stumbled behind Thomas toward the parking garage.

Once inside the garage, he stopped and, finally turning to Cassi, said, “Awful weather.”

“We’re paying for such a nice fall,” said Cassi, encouraged that Thomas did not seem to be in a bad mood. Maybe Patricia would not tell him of the visit to his study.

The engine of the Porsche reverberated like thunder in the garage. As he watched the dials and gauges, Cassi carefully did up her seat belt. It took a conscious effort for her not to tell Thomas to do his, especially given the bad weather, but remembering his previous response, Cassi remained silent.

Whenever it snowed, traffic in Boston slowed to a frustrating stop-and-go mess. As Thomas and Cassi proceeded east on Storrow Drive, it was mostly stop. Although Cassi wanted to talk, she was afraid to break the silence.

“Did you hear from Robert Seibert today?” Thomas finally asked.

Cassi swung her head around. Thomas still had his eyes on the road despite the fact that the car was immobilized in a sea of red taillights. He seemed hypnotized by the rhythmic click-clack of the windshield wipers.

“I did speak to Robert today,” admitted Cassi, surprised at the question. “How did you know?”

“I’d heard that one of George Sherman’s patients had died. Apparently it wasn’t expected, and I wondered if your friend Robert was still interested in that series of his.”

“Absolutely,” said Cassi. “I went up after the autopsy. And when I did, Robert told me how you rescued him at death conference. I think that was very nice of you, Thomas.”

“I wasn’t trying to be nice,” said Thomas. “I was interested in what he had to say. But he was a fool to do what he did, and I still think he should get his butt kicked.”

“I think he did get his butt kicked,” said Cassi.

With a faint smile Thomas took advantage of the thin-ning traffic and goosed his car up the grade to the expressway.

“Was this last death another suspicious one?” he asked as the car accelerated to seventy. He drove with both hands on the wheel, blinking his high beams furiously as he came up behind people traveling more slowly.

“Robert thinks so,” said Cassi, her hands involuntarily gripping each other. Thomas’s driving always scared her. “But he hasn’t done the brain yet. He thinks the patient convulsed prior to death.”

“So it wasn’t like the last case?” asked Thomas.

“No,” said Cassi. “But Robert thinks the situations are related.” Purposely she kept her own role in the discussion secret. “Most of the patients, particularly over the last several years, have died after their acute postoperative course was over. One point that occurred to Robert today was that all the patients may have been on IV when they died. He’s checking on that now. It could be significant.”

“Why? Does Robert think these deaths could be suspicious?” asked Thomas with shock.

“I guess it’s occurred to him,” said Cassi. “After all, there was a case in New Jersey where a series of patients were given something like curare.”

“That’s true, but they all died with the same symptoms.”

“Well,” said Cassi. “I guess Robert feels that he has to consider all possibilities. I know it sounds awful and it certainly accentuates any insecurities Robert has about his own imminent surgery.” Cassi was hoping to shift the topic to her own operation.

“What kind of surgery is Robert going to have?”

“He’s finally having his impacted wisdom teeth removed. Since he had rheumatic heart disease as a child, he has to be treated with prophylactic antibiotics.”

“He’d be a fool not to,” agreed Thomas. “Although he must have suicidal tendencies. That’s the only way I can explain his behavior at that death conference. Cassi, I want you to be sure to stay away from this so-called SSD study, especially if there are going to be ludicrous accusations. With everything else going on, I certainly don’t need that kind of grief.”

Cassi watched the cars in front as the Porsche relentlessly passed them. The monotonous movement of the windshield wipers mesmerized her as she tried to find the courage to broach her own operation. She’d promised herself she’d start speaking as soon as they came abreast of that yellow car. But the yellow car soon dropped behind them. Then it was the bus. But they’d passed that, too, and still Cassi remained silent. She gave up in despair, hoping that Thomas would bring up the subject himself.

The tension exhausted her. The idea of Ballantine’s party seemed less and less attractive. She had trouble understanding why Thomas, of all people, wanted to go. He hated hospital affairs. The idea occurred to Cassi that maybe he was going for her benefit. If that were the case, it was ridiculous. All Cassi could think about was clean sheets and their comfortable bed. She decided she’d say something when they got to the next overpass.

“Do you really want to go to this party tonight?” asked Cassi hesitantly as an overpass flashed above them.

“Why do you ask?” Thomas pulled the car sharply to the right, then gunned the engine to pass a car that had ignored his blinking high beam.

“If you’re going for me,” said Cassi, “I’m exhausted. I’d much rather stay home.”

“Goddammit,” shouted Thomas, banging the steering wheel. “Must you always think only of yourself! I told you weeks ago that the board of directors and the deans of the medical school are going to be there. Something strange is going on in the hospital that they are not telling me. But I don’t suppose you think that’s important?”

As Thomas reddened with anger, Cassi sank in her seat. She had a feeling that no matter what she said, it would only make matters worse.

Thomas lapsed into a sullen silence. He drove even more recklessly, taking the car up to ninety as they crossed the salt marshes. Despite the seat belt, Cassi found herself being thrown from side to side as the car rounded the sharp bends. She was relieved when he began to down shift before turning into their driveway.

By the time they got to the front door, Cassi had become resigned about the party. She apologized for not understanding its implications and added gently, “You look tired yourself.”

“Thanks! I appreciate your vote of confidence,” said Thomas sarcastically. He started for the stairs.

“Thomas,” called Cassi desperately. She could tell he’d interpreted her concern as an insult. “Does it have to be like this?”

“I think this is the way you want it.”

Cassi tried to object.

“Let’s not have a scene, please!” yelled Thomas. Then in a more controlled voice he said, “We’ll leave in an hour. You’re the one who looks terrible. Your hair is a mess. I hope you’re planning on doing something with it.”

“I will,” said Cassi. “Thomas, I don’t want us to fight. It terrifies me.”

“I’m not getting into this kind of discussion,” snapped Thomas. “Not now. Be ready in an hour.”

Hurrying into his study he went directly to the bathroom, mumbling under his breath about Cassi’s selfishness. He’d told her very specifically about the party and why it was important, but she’d conveniently forgotten because she was too tired! “Why do I have to put up with this,” he said, running a hand over his beard.

Getting out his shaving paraphernalia, Thomas washed and lathered his face. Cassi was becoming more than a source of irritation. She was becoming a burden. First her eye problems, then her preoccupation with the fact he took an occasional drug, and now her association with Seibert’s provocative paper.

Thomas began to shave with short, irritated strokes. It was beginning to feel as if everyone were against him, both at home and in the hospital. At work the key offender was George Sherman, who was constantly undermining him with all the supposed teaching bullshit. Just thinking about it filled Thomas with such frustration that he threw his razor into the shower with all the force he could muster. It ricocheted off the tiled walls with a clatter before coming to rest near the drain.

Leaving the razor where it was, Thomas got into the shower. The running water always tended to soothe him, and after he’d stood under the spray for a few minutes, he felt better. While he was drying, he heard the door to his study open. Expecting it was Cassi, he didn’t bother to look, but when he was done in the bathroom, he opened the door to find Patricia sitting in his armchair.

“Didn’t you hear me come in?” she asked.

“No,” said Thomas. It was easier to fib. He went to the cabinet below the bookshelves where he’d been keeping some of his clothes.

“I can remember when you used to take me to these hospital parties,” said Patricia plaintively.

“You’re welcome to come,” said Thomas.

“No. If you’d really wanted me you would have invited me rather than making me ask.”

Thomas thought it better not to respond. Whenever Patricia was in one of these “hurt” moods, it was safer to say nothing.

“Last night I saw the light come on in the study here, and I thought you’d come home. Instead I found Cassandra in here.”

“In my study?” demanded Thomas.

“She was right over there behind your desk.” Patricia pointed.

“What was she doing?”

“I don’t know. I didn’t ask her.” Patricia stood up with a self-satisfied expression. “I told you she would be trouble. But, oh no! You knew better.” She sauntered out of the room and closed the door gently behind her.

Thomas threw his clean clothes onto the sofa and went to his desk. Pulling out the drawer with his drugs, he was relieved to see the bottles of pills exactly as he’d left them behind the stationery.

Even so Cassi was driving him crazy. He’d warned her to stay away from his belongings. Thomas could feel himself begin to shake. Instinctively he reached into his cache of pills and extracted two: a Percodan for the headache he could feel behind his eyes and a Dexedrine to wake him up. If it was worth going to this party, he should at least be alert.

• • •

Cassi could sense a tremendous change for the worse in Thomas’s mood as they drove toward Manchester. She’d heard Patricia come into the house and guessed that she’d visited Thomas. It didn’t take too much imagination to figure out what she’d told him. Since Thomas had already been in poor humor, she couldn’t have chosen a worse time.

Cassi had made a real effort to look her best. After taking her evening insulin, which she’d upped because of sugar showing up in her urine, she’d bathed and washed her hair. Then she’d selected one of the dresses that Robert had suggested. It was a deep brown velvet with puffed sleeves and a tight bodice that gave her a charming medieval look.

Thomas said nothing about her appearance. In fact he said nothing at all. He drove the way he had coming from the hospital, recklessly and fast. She wished he had a close friend she could go to-someone who really cared for him, but in truth he didn’t have many friends at all. For a moment she was reminded of her last meeting with Colonel Bentworth. Then she caught her breath. Identifying with Maureen Kavenaugh was one thing, but comparing her husband to a borderline personality was ridiculous. Cassi turned her attention to the window to keep from thinking and tried to see through the moisture. It was a dark, forbidding night.

The Ballantines’ house fronted on the ocean, just like Thomas’s. But that was where the similarities ended. The Ballantines’ home was a large, stone mansion and had been in the family for a hundred years. In order to maintain the house, Dr. Ballantine had sold off some of the land to a developer, but since the original plot was so large, no other house could be seen from the main building. It gave the impression of being in the country.

As they got out of the car, Cassi noticed that Thomas had a slight tremor. His coordination seemed slightly off as they mounted the front steps. Oh God, what had he taken?

Thomas’s demeanor changed as soon as he joined the party. Cassi watched with amazement, although she knew how easily he could abandon an angry mood and become charming and animated. If only he would still expend some of that charm on her. Deciding it was safe to leave him, Cassi began to look for the food. Having given herself her evening insulin, she shouldn’t wait too long before eating. The dining room was to the right, and she made her way over to the arched entrance.

Thomas was pleased. As he’d expected, most of the hospital trustees and the deans of the medical school were at the party. He’d seen them over the shoulders of the small group of people he’d joined when first arriving. He was particularly interested in finding the chairman of the board. Picking up a fresh drink, he began to make his way through the crowd toward the men when Ballantine came over to him.

“Ah, there you are Thomas.” Ballantine had been drinking heavily, and the circles under his eyes were pronounced, giving him more the appearance of a Basset hound than usual. “Glad that you could make it.”

“Wonderful party,” said Thomas.

“You better believe it,” said Ballantine with a forceful wink. “Things are really happening at the old Boston Memorial. God, it’s exciting.”

“What are you talking about?” asked Thomas, backing up a step. Dr. Ballantine had a habit of spitting when he pronounced “Ts” after he’d had a few drinks.

Ballantine stepped closer. “I’d like to tell you, but I can’t,” he whispered. “But maybe soon, and I think you should join us. Have you given any thought to my offer of full professorship?”

Thomas felt his patience evaporate. He didn’t want to hear about joining the full-time staff. He had no idea what Ballantine was referring to when Ballantine said, “Things are really happening.” But Thomas didn’t like the sound of it. As far as he was concerned, any change in the status quo was worrisome. He suddenly recalled seeing Ballantine’s office light blazing at 2:00 A.M.

“What were you doing in your office so late last night?”

Ballantine’s happy face clouded. “Why do you ask?”

“Just curiosity,” said Thomas.

“That’s a strange question just coming outta the blue,” said Dr. Ballantine.

“I was in surgery last night. I saw your office light from the lounge.”

“Must have been cleaning people,” said Ballantine. He raised his glass and stared at it. “Looks like I need a refill.”

“I also saw George Sherman’s car in the garage,” said Thomas. “It seemed an odd coincidence.”

“Ah,” said Ballantine, with a wave of his hand. “George’s been having trouble with that car for a month. Something with the electrical system. Can I get you another drink? You’re as low as I.”

“Why not?” said Thomas. He was sure Ballantine was lying. The moment the chief edged toward the bar, Thomas recommenced his search for the chairman. It was more important than ever to find out what was going on at the Memorial.

• • •

Cassi stayed by the buffet table for a while eating and chatting with several other wives. When she was sure she had absorbed enough calories to balance her insulin, she decided she’d better find Thomas. She had no idea what drugs he’d taken, and she was nervous. She had just started for the living room when George Sherman stopped her.

“You look beautiful, as usual,” he said with a warm smile.

“You look good yourself, George,” said Cassi. “I like you far better in a tuxedo than that old corduroy jacket of yours.”

George laughed self-consciously.

“I’ve been meaning to ask how you find psychiatry. I was surprised when I heard you’d made the switch. In a lot of ways, I envy you.”

“Don’t tell me you give psychiatry any credibility. I didn’t think any surgeon did.”

“My mother suffered a severe postpartum depression after my younger brother was born. I’m convinced her psychiatrist saved her life. I might have chosen it as a specialty if I thought I would have been successful. It takes a sensitivity I don’t have.”

“Nonsense,” said Cassi. “You have the sensitivity. I think it would be the passivity that would give you trouble. It’s the patient who has to do the work in psychiatry.”

George was silent for a moment, and as Cassi watched his face she suddenly thought of fixing him up with Joan. They were both such nice people.

“Are you interested in meeting an attractive new woman these days?”

“I’m always interested in attractive women. Though few measure up to you.”

“Her name is Joan Widiker. She’s a third-year psychiatry resident.”

“Wait a second,” said George. “I’m not sure I can handle a psychiatrist. She’ll probably ask me all sorts of tough questions when I drag out my whips and chains. I might be too self-conscious. Worse than when I was with you. Remember that first date?”

Cassi laughed. How could she forget? George had clumsily knocked her hand during dinner so that she’d spilled linguini Alfredo into her lap. Then, in his eagerness to help mop it up, he’d knocked her Chianti Classico into her lap as well.

“I don’t mean to sound ungrateful,” said George. “I do appreciate your thinking of me and I’ll give Joan a call. But Cassi, I wanted to talk to you about something a little more serious.”

Cassi unconsciously straightened, unsure of what was coming.

“As a colleague, I’m worried about Thomas.”

“Oh?” said Cassi as casually as she could.

“He works too damn hard. It’s one thing to be dedicated, quite another to be obsessed. I’ve seen it before. Often physicians can go along at nine hundred miles an hour for years and then suddenly burn themselves out. The reason I’m saying all this is to ask you to try to get Thomas to slow down, maybe take a vacation. He’s been wound up like a coiled spring. There’s gossip he’s had a couple of bad arguments with the residents and nurses.”

George’s words awakened all Cassi’s submerged tears. She bit her lip, but remained silent.

“If you could get him to take some vacation time, I’ll be happy to cover his practice if need be.” George was startled to see Cassi’s eyes fill with tears. She turned away, hiding her face.

“I didn’t mean to upset you,” said George. Reaching out, he put his hand on her shoulder.

“It’s all right,” said Cassi, struggling to regain her composure. “I’m okay.” She looked up and managed a smile.

“Dr. Ballantine and I have discussed Thomas,” said George. “We’d like to help. We both think that when someone works as hard as Thomas, he has to recognize that there’s an emotional price to pay.”

Cassi nodded as if she understood. She gave George’s hand a squeeze.

“If you feel uncomfortable talking to me, maybe see Dr. Ballantine. He thinks the world of your husband. Maybe you’d like the chief’s private extension at the hospital?”

Cassi evaded George’s warm gaze. Concentrating on her purse, she extracted a small notepad and pencil. When George gave her the number, she wrote it down. When she looked up, her heart almost stopped. She found herself looking directly into Thomas’s unblinking stare. With knowledge born of intimacy, she instantly knew he was violently angry. All at once, George’s hand felt heavy on her shoulder.

She quickly excused herself, but by the time she moved toward the door, Thomas had disappeared.

Thomas hadn’t been so angry since he was a freshman in college and one of his roommates had dated Thomas’s girl friend. No wonder George had been acting so strangely. He’d been renewing his affair with Cassi, and Cassi had no more sense than to display her interest in front of all Thomas’s colleagues. The cold knot of fear in the pit of his stomach stirred. His hand shook so badly he almost spilled his drink. Quickly tossing it off, he stepped through the French doors onto the veranda, welcoming the sharp ocean breeze.

Frantically he searched his pockets for a pill. The evening had gone badly from the start. A trustee who’d already made several trips to the bar had stopped to offer congratulations on the hospital’s new teaching program. When Thomas had stared blankly in response, the man had muttered a quick apology and backed out of the room. Thomas had been about to search out Ballantine and demand an explanation when he’d seen Cassi.

God, what a fool he’d been. Now that he thought about it, it was obvious George and Cassi were having an affair. No wonder she never complained when he stayed so often in the hospital. Mercilessly his mind teased him with the idea that they met in his house. The image of George in their bedroom made Thomas cry out in rage. Glancing over his shoulder, he saw a couple standing in the doorway, and Thomas was suddenly afraid they were aware of the affair. Obviously they were talking about him. He pulled out another pill, swallowed it, and went back inside for another drink.

Frantic to find Thomas, Cassi began to work her way around the living room, excusing herself as she squeezed among the guests.

She was on her way into the bar when she found herself face to face with Dr. Obermeyer.

“What a coincidence!” he said. “My most difficult patient!”

Cassi smiled nervously. She remembered she’d reneged on her promise to call him that day.

“Unless my memory fails, you were supposed to schedule your surgery today,” said Dr. Obermeyer. “Did you talk to Thomas about it?”

“Why don’t I come to your office tomorrow morning,” said Cassi evasively.

“Maybe I should talk to your husband,” said Dr. Obermeyer. “Is he here?”

“No,” said Cassi. “I mean, yes he’s here, but I don’t think this is the time…”

A tremendous yell shook the room, halting all conversation and stopping Cassi in midsentence. Everyone looked confused; everyone but Cassi. She recognized the voice. It was Thomas! Running back toward the dining room, she heard another shout, followed by a crash of broken glass.

Pushing her way through the other guests, Cassi saw Thomas standing in front of the buffet, his face flushed with anger, a number of broken plates at his feet. Staring at him in horrified surprise was George Sherman, a drink in one hand and a carrot stick in the other.

As Cassi watched, George reached out and patted Thomas’s shoulder with the carrot, saying, “Thomas, you’re mistaken.”

Thomas knocked George’s arm away with a vicious snap of his wrist. “Don’t touch me! And don’t ever touch my wife. Understand?” He jabbed a threatening finger into George’s face.

“Thomas?” said George helplessly.

Cassi ran between the two men. “What is the matter with you, Thomas?” she said, grabbing his jacket. “Control yourself!”

“Control myself,” he repeated, turning toward her. “I think that applies more to you than me.”

With a final sneer, he shook himself from Cassi’s grasp and headed for the front door. Ballantine, who’d been in the kitchen, followed, calling his name.

Cassi apologized quickly to George and moved toward the door, her head bent to avoid the curious stares.

Thomas meanwhile had found his coat and was saying angrily to Ballantine, “I’m terribly sorry about all this, but learning that one of your colleagues is having an affair with your wife is hard to take.”

“I, I can’t believe that,” said Ballantine. “Are you sure?”

“I’m sure,” said Thomas. He turned to open the door as Cassi ran up and caught his arm.

“Thomas, what are you doing?” she said, fighting tears.

Thomas didn’t answer. Buttoning his coat, he turned to leave.

“Thomas, talk to me. What happened?”

Thomas yanked his arm away from Cassi with such force she almost fell to the ground. She hesitated as he opened the door and stormed outside.

Cassi caught up to him at the bottom of the steps.

“Thomas, if you’re going to leave, then I’m coming. Let me get my coat.”

Thomas stopped short. “I don’t want you with me. Why don’t you just stay here and enjoy your affair!”

Confused, Cassi watched him walk away. “My affair? This is your affair. I didn’t want to come tonight!”

Thomas didn’t respond. Cassi gathered up the skirt of her long dress and ran after him. By the time she reached the Porsche she was shaking violently, but she didn’t know whether it was from fear or the cold.

“Why are you acting this way?” she sobbed.

“I might be a lot of things, but I’m not stupid,” snapped Thomas, slamming the car door against her. The engine started with a roar.

“Thomas, Thomas,” called Cassi, beating against the window with one hand and trying to open the door with the other. Thomas ignored her and backed up quickly. If Cassi had not stepped back, letting go of the car, she would have been pulled down. Staring mutely, she watched the Porsche roar down the long driveway.

Mortified, she turned back to the house. Perhaps she could hide in one of the upstairs rooms until she could get a cab. When she reached the foyer, she was relieved to see the guests were again busy drinking and laughing. Only George and Dr. Ballantine were waiting at the door.

“I’m so sorry,” Cassi said uneasily.

“Don’t be sorry,” said Dr. Ballantine. “I understand George has had a little talk with you. We are concerned about Thomas and think he’s overworking. We have plans that will lighten his load, but he’s been so upset lately that we haven’t had the opportunity to discuss it with him.”

Ballantine exchanged glances with George.

“That’s right,” agreed George. “I think this unfortunate episode tonight just underlines what we’re saying.”

Cassi was too upset and confused to respond.

“George also mentioned,” said Ballantine, “that he gave you my private extension at the hospital. I’ll be happy to see you any time you want, Cassi. In fact, why don’t you stop by my office tomorrow?”

“Now, would you like to rejoin the party?” asked Ballantine, “or would you rather one of my boys drove you home?”

“I’d like to go home,” said Cassi, wiping her eyes with the back of her hand.

“Fine,” said Ballantine. “Just a moment.” He turned and mounted the stairs to the second floor.

“I am sorry,” said Cassi to George when they were alone. “I don’t know what got into Thomas.”

George shook his head. “Cassi, if he knew how I really felt about you, he’d have every reason to be jealous. Now smile. I was just paying you a compliment.” He stood, gazing fondly at her until Ballantine’s son brought the car around.

Cassi didn’t know what to expect when she turned the key in her front door. She was surprised to see a light in the living room. If Thomas was home and not in the hospital, she assumed he would be locked in his study. Nervously, she walked through the hall straightening her hair as best as she could.

But it was her mother-in-law, not Thomas, who was waiting for her.

Patricia was seated in a wingback chair, her face lost in the shadowy light of a single floorlamp. Upstairs, Cassi heard a toilet flush.

For a long time neither woman spoke. Then Patricia stiffly stood up, her shoulders bowed as if under a heavy weight. Her face was drawn, accentuating the lines around her mouth. She walked directly up to Cassi and looked her in the eye.

Cassi held her ground.

“I’m shocked,” she said at last. “How could you have done this? Maybe if he weren’t my only child it wouldn’t hurt so much.”

“What on earth are you talking about?” demanded Cassi.

“And to pick one of Thomas’s colleagues,” Patricia went on, ignoring the younger woman. “A man who has been steadily trying to erode his position. If you wanted an affair, why not a stranger?”

“I’m not having an affair,” said Cassi desperately. “This is absurd. Oh God, Thomas is not himself.”

She watched her mother-in-law for some sign of understanding, but Patricia stood rigidly looking at her daughter-in-law with a mixture of sadness and anger.

Cassi stretched her arms toward the woman. “Please,” she pleaded. “Thomas is in trouble. Won’t you help?”

Patricia remained unresponsive.

Letting her arms fall to her sides, Cassi watched as Patricia walked haltingly to the door. She seemed to have aged ten years since Cassi had last seen her. If only she’d listen. But Cassi realized at last that Patricia would rather break her heart over a lie than deal with the more frightening truth of Thomas’s addiction. As much as Patricia criticized Thomas, Cassi knew that she could never conceive of the possibility of something significantly wrong with her son.

Cassi remained in the semidarkness of the living room for a long time after she heard the front door close. She’d cried more tears in the last forty-eight hours than she had for the previous twenty years. How could Thomas possibly believe she was having an affair? The idea was preposterous.

With heavy steps she finally ascended the stairs to find Thomas. There was no way she could just go to bed. She had to try to speak to him. For a moment she hesitated outside the study. Then she knocked softly.

There was no answer.

She knocked again, louder. When there was still no reply, she tried the door. It was locked. Determined to talk with him, she walked to the guest room and entered the study through the connecting bathroom.

He was sitting immobile in his easy chair, staring straight ahead, his eyes unfocused. If he heard Cassi, his expression did not change. A slight smile lifted the corners of his mouth. Even after Cassi knelt down and pressed his hand to her cheek, he did not move.

“Thomas,” she called softly.

Thomas finally looked down at her.

“Thomas, I’ve never had an affair with George. I’ve never looked at anyone since we met. I love you. Please let me help.”

“I don’t believe you,” Thomas said, badly slurring his words. Then his eyes rolled up and he passed out, leaving Cassi still holding his hand. She unfolded the sofa bed and tried to get him to move, but he refused. She sat with him for a while before going back to her own room to try to sleep.