The Inquisitor

Chapter 13

Janet dashed through the corridor, guiding the stretcher around corners, the race a deadly earnest repeat of what they'd done in jest through the streets of Buffalo two Saturdays ago.

Even Jimmy helped, setting intravenous bottles swaying in the turns as he muscled their precious cargo along.

Stewart Deloram adjusted IV rates on the run.

Janet continued to utter a steady stream of comforting words- reassuring J.S. that all would be well, that they'd beaten these odds many, many times before, that this would soon be little more than an unpleasant memory. But she couldn't be sure her patient even heard, and she estimated they had ten minutes to stop the flow of blood or J.S. would die.

They commandeered an elevator and seconds later were met by a team of nurses and an anesthetist who ushered them into an OR.

The bleeding continued.

Changing, scrubbing, then redonning sterile gowns, gloves, and masks cost more precious minutes.

"Pressure's down to sixty-two," called out one of the OB nurses.

Stewart rushed to open up the IVs as wide as they'd go.

Jimmy hustled back to J.S.'s side. No stranger to keeping out of the way, he hovered discreetly by her head, holding her hand and talking quietly to her, until a nod from the anesthetist indicated she'd finally been put under. He then stepped back into a corner, apparently determined to stay and observe, his dark eyes glistening.

Janet recognized in them what she'd never seen him show before: fear.

My God, he's in love with her, she thought.

"Ready for you, Doctor," said the anesthetist, his voice clipped and urgent. "Pressure's falling, sixty over zip." He had the requisite wisps of gray hair sticking out from under his cap to tell her she hadn't pulled a rookie.

The nurses secured J.S.'s legs in stirrups and positioned an OR stool adjusted for Janet's height between them. Taking her seat, Janet prepared to do the definitive treatment- scrape any pieces of afterbirth off the inner lining of the uterus. With nothing left in the way, the organ could clamp down tight on itself and tamponade the bleeding sites, like pressure on a cut.

The os of the cervix hung open, pouring blood, and tissue trailed out its orifice, debris caught in a stream.

"Suction," she ordered.

Catheters drained everything away with the sound a straw makes at the bottom of a milk shake, and the crimson flow receded.

Janet quickly inserted a dilator to widen the passage, then went into the vault with a curette to clean out any remaining material.

"Still sixty over zip, and pulse climbing to one sixty. You may not have much time." The anesthetist spoke the grim warning with glacial cool.

"Keep calling out the readings." She retrieved only small amounts of tissue, yet blood continued to pour over her hands, warm and fluid with not a clot in sight.

Definitely something wrong with her coagulation.

"Any repeat on the INR?" she asked.

"Still high, but the rest is okay," Stewart replied. In other words, low prothrombin remained the problem, not the more horrific DIC, at least so far.

He continued to work frantically with the IVs- replacing spent packets of red cells and plasma, binding the new ones in pneumatic cuffs that accelerated their flow, hanging up more liters of saline to pour in as much volume as possible- all to keep her circulation from collapsing completely. The dread in his eyes said, I'm losing!

"Fifty-five over zip."

Janet finished raking the curette over the inner uterine wall and pulled out the last segments of the afterbirth, none of it enough to explain such a copious hemorrhage. There should have been some improvement by now.

Unless…

"BP down to fifty, pulse is still high… one fifty-five… one sixty…"

She'd soon arrest.

A cold sweat crept up Janet's back.

Either the coagulation problem hadn't corrected at all, or in doing the curettage, she'd shoved the instrument right through the uterine wall and opened up a new bleed. Pliant enough to expand and accommodate the size of a baby, the tissue is delicate, and a curette could penetrate it without her ever feeling the pop of the metal tip punching all the way through. She'd never made the mistake before, but shit happens when you least want it.

She'd have to go in and check.

"A number eleven scalpel," she ordered, removing the curette. "Prepare for a laparotomy and a repair of a possible uterine puncture."

She heard the indrawn breaths as everyone's pupils pulsed wider, but nobody said a word. From now on she'd be the only one to speak.

The nurse at her side snapped a pointed blade onto a stainless-steel handle and laid it flat in her outstretched hand.

Her colleagues shoved the additional instrument trays they'd need into easy reach and whipped off the sterile covers. One of them quickly prepped the area she'd be cutting.

Stewart slid a nail-sized needle under J.S.'s collarbone and into her subclavian vein to start a sixth IV.

"Get ready to tamponade the incision with gauze, and give me suction, plenty of it."

In a single move Janet made a four-inch horizontal slice through the skin into a yellow layer of subcutaneous fat, following along the top of the pelvis, the so-called bikini cut. Immediately the trench filled with blood, but the nurses' fingers pulled the edges apart and pressed folded white gauze into the incision, soaking up the flow as fast as it appeared.

In a second pass she cut deeper, parting the yellow globules where she'd left off down to the glistening white fascia that lined the abdominal muscle. Across this layer she made a third sweep with just the tip of her blade, and the diaphanous sheet sprang open, permitting strands of maroon-bellied muscle to bulge out. Handing back the scalpel, she quickly separated them with her fingers, working around the catheters that noisily sucked out the blood, making her way down to the pearl-gray membrane that lined the pelvic cavity. Without needing to be asked, two nurses assumed the task of holding the tissue apart with small stainless-steel claws as she went.

Once she'd cleared enough space, a third nurse slapped a pair of pointed tweezers into Janet's left hand and surgical scissors into her right. Using the former to snag the membrane, she lifted it enough to make a tiny tent and snipped another four-inch opening.

Retracting the edges with her fingers, she brought the dark maroon surface of the pear-shaped uterus into view. Gleaming like new, it lay in a blood-free bed of ligaments and ocher-colored membranes.

Perhaps she hadn't perforated it after all. To be sure, she delicately explored the slippery contours with her fingertips, checking for any tiny holes.

None.

She watched it for leakage.

Crimson seepage from severed vessels in the skin flowed into the space, but nothing else. The exterior remained intact, giving the appearance of a womb as ready to receive and grow life as always.

But from its interior the unrelenting flow persisted, silently coursing out between J.S.'s legs to spatter noisily into the most recent steel basin the nurses had placed there.

After the rush of activity, Janet felt overwhelmed with helplessness. She'd reached the limit of what she could do.

More vitamin K wouldn't help. It took hours to work.

Removing the uterus would produce more hemorrhages.

The sole hope for survival rested with the fresh frozen plasma- if the clotting factors kicked in soon enough.

She prepared herself for the hardest task a surgeon had to endure: to stand by and let time decide life or death.

"Pressure?"

"Fifty-five," the anesthetist reported, his voice as ice-smooth as ever.

No one else said a word.

In the silence, each squeeze of the ventilation bag seemed to become louder.

The tiny intervals between the rapid stream of beeps from the heart monitor grew so infinitesimal that the noise approached a continuous scream.

And the spatter of blood filling yet another basin ran steady as a faucet.

One of the nurses emptied it and recorded the amount.

Others counted the blood-soaked gauzes that lay in foot-high piles on the surrounding trays, estimating each to hold a twenty-cc loss. J.S.'s heart would either find enough volume of blood to pump or collapse in on itself, empty. And even if she continued to have a pulse, whether the rest of her vital organs- brain, kidneys, liver- could scavenge enough molecules of oxygen from the sparse circulation to survive intact, Janet had no idea.

With nothing to do but wait, she drew on raw nerve honed by years of experience to just stand there, outwardly calm but seething inside, suffocated under a sense of dread that she'd lost J.S.

Then she thought of Jimmy and what he must be going through.

When she glanced in his direction, he remained as still as a sentinel, yet gave her a nod, as if to say it would be all right.

J.S. went into full cardiac arrest at 4:10 a.m.

Stewart cracked open her chest, slid his gloved hand into the cavity, and did open-heart massage.

As he worked, the bleeding slowly subsided.

Because she's dying, Janet told herself.

Nearly five minutes later the anesthetist said, "You're getting a good pulse."

Thirty seconds after that the heart resumed pumping on its own, coming back to life in Stewart's hand.

As Jane's pressure climbed, everyone waited for the bleeding to resume.

It didn't.

Later that same morning, 7:30 a.m. The roof garden, St. Paul's Hospital

"I tell you, Earl, he was terrific," Janet said, throwing her arm around Stewart's shoulders. "Absolutely terrific."

The man reddened, but the corners of his eyes betrayed a smile. "Janet's the one who called the shots," he said, unusually muted in the face of praise.

Falling to the status of pariah and then reclaiming the mantle of hero in less than a day can have that effect on a person, even a resident prima donna, Earl thought, not exactly comfortable with Janet heaping such unqualified accolades on a man who still had a lot to answer for.

Stewart seemed uneasy as well, having difficulty looking him in the eye.

The sounds of morning traffic floated up from the street below, and overhead an azure sky stretched out over Lake Erie to where water and air became indistinguishable and the horizon disappeared in a blue haze. The coming day would be a scorcher, and as at the start of most shifts since the roof garden opened, a lot of staff had gathered here to talk and savor the coolness while it lasted. While some still gave Stewart a stink-eye scowl, many of the nurses who'd done the same yesterday now came up to him and said, "Thanks for saving her."

As for J.S., she lay in ICU, still unconscious, but, with her vitals stable and blood chemistry normal, expected to recover. Even the problematic INR had returned to a reasonable level, probably thanks to the vitamin K. The hematologists would be keeping an eye on it. "Thank God she'll be okay," Earl said to Stewart, his tone guardedly neutral. "Who got her pregnant?" he then asked, wanting to shift the conversation.

Janet's eyes sparkled. "You're going to love this. As soon as his shift in ER ended,

Thomas Biggs showed up at her bedside, attentive as hell. Looks like you had a discreet romance under your nose."

"Thomas?"

"That's right. Surprised me too. For a moment, I even thought it might have been Jimmy, the way he stuck to her-"

"Well, if you'll excuse me, I'm going home," Stewart interrupted, sounding tired as he unfolded his tall frame from the bench. "At least now I ought to be able to sleep."

"You deserve it," Janet said warmly, giving his arm a squeeze.

"You're awfully friendly with him," Earl said after he'd left. He hadn't had a chance to talk with Janet privately since the events at death rounds yesterday morning.

"You believe what that Monica Yablonsky's saying?" she asked, the skeptical arch of her voice and eyebrows making her own opinion clear.

"I'm not sure."

"Only not sure? Come on!"

"Well, I agree that he wouldn't be so stupid as to rig a bunch of near-death experiences."

"But?"

"Even if he had nothing to do with that, I don't know how far he'd go to try and prevent that story from coming out."

Janet frowned. "You mean to say you think he knocked off the patients who reported those stories?"

"It's a terrible thought, but… yes."

"Jeez!" She looked out over the lake, her blue eyes darkening, growing as deep and faraway as the distant water. "I know he can sure get prickly over what people say about him, almost paranoid at times." She shook her head. "But to actually silence people, cause them to die or slip into comas… that's a hell of a leap." She exhaled hard, inflating her mask around her cheeks. "But the trouble with thinking the worst about someone is that once you start, it's hard to stop."

"Tell me about it. Better yet, tell me I'm wrong."

She breathed out a second time, hard, as if doing her breathing exercises in preparation for labor. "I can't say I don't know what you mean. Stewart has always been a difficult read. And if anyone could tweak a patient over the edge without leaving a trace, he's got the skills." A shudder passed through her. "As wonderful as what he pulled off with J.S. might be, it always kind of scared me, seeing how he throws himself into a case on the brink. There's a desperation to it. Oh, I know anyone in our business who's really good has to be obsessive about getting all the details right- we all are- but I don't think I realized before just how consumed he is by what he does. It's like he hides in it. But would he kill to protect his right to play God?" She again shook her head. "I just don't know."

Earl felt more uneasy than ever. Part of him had hoped she would dismiss his concerns about Stewart. Time to once more change the topic. "What about supper tonight? Remember, I invited Thomas over. Are you going to be up for working on stats with him?"

She arched her back into a stretch and gave a big yawn. "He already told me to expect him."

Earl felt a flash of annoyance. "Really? You look exhausted."

"Don't worry. After I look in on a few patients, I'll sign out and go home to bed. Brendan will get another surprise treat when he comes back from school and finds me there, and we'll make the meal together."

"From what you said, I would have thought Thomas might want to be with J.S."

"There's that too. But seems he's more determined than ever to discover what's going on in Palliative Care. I got the impression he'd totally changed his mind about Stewart and wants to help clear his name, all because Stewart saved J.S. Ain't love grand?"

Earl frowned. "Wait a minute. He can't turn this into some damn personal crusade."

Janet got up to leave. "Don't worry. I'll keep Thomas in line. Besides, I already explained to him that a profile on Stewart's presence in the hospital wouldn't work. Trouble with a guy who has no life is that he's always here, so a cluster study on him wouldn't be valid."

Earl had an idea. "It might be if you look at when he's not here."

"What?"

Minutes later he stood leaning over her shoulder as she sat in front of her office computer screen and clicked up some of the Palliative Care statistics they'd been scrutinizing the last few days. "Locate the initial numbers that showed the first jump in the mortality rate six months ago, then go to the second increase, last

April, just after the SARS outbreak," he told her.

She brought them up on the screen. The first three columns showed a rise of eleven deaths a month that held steady, and the last three indicated the second increase of fourteen patients a month.

"Now break down the data so we see it by the week."

Six big columns of figures became twenty-six shorter lists. Within any given month, the numbers held steady week to week.

"Now," he said, "you remember those media junkets Stewart went off on?"

"Oh, my God, yes."

"One was at the beginning of the year. Believe me, I remember, because ER is always hell without his help."

"Then let's see…" She clicked up the mortality figures in Palliative Care for that period and broke them down according to days.

Sure enough, while Stewart had been in New York, Chicago, and LA gabbing with Connie, Larry, Letterman, Oprah, and Jay, the numbers of people dying in palliative care held more or less steady at the then new high of 25.6 patients a week, or 3.6 per twenty-four hours.

"At least we can forget about him having anything directly to do with the first overall rise," she said.

Earl thought a moment. "It doesn't rule out the possibility that he had an accomplice, and it sheds no light at all on whether he had anything to do with silencing five patients a few days ago."

7:56 a.m.

ICU, St. Paul's Hospital

Jane Simmons felt the darkness. It pressed into her nose, into her mouth, and down her throat, suffocating her the way black earth would if someone had buried her alive.

In a panic, she clawed her way to the surface, back aboveground, until a hand grabbed hers and pulled her toward the light. "Jimmy?" she tried to say, opening her eyes, but choked on what felt like a hose down her throat.

Thomas's dark brown gaze greeted her. "Hi, love," he said, his voice very soft. "Welcome back."

For an instant the sight of him confused her, and the beeping sounds from behind her head, though familiar, seemed totally out of place. It took a second more to realize she had a half dozen IVs sticking into her, a tube in the left part of her chest, and a respirator hooked up to her lungs.

Then she remembered.

The pain, the blood, ER… Jimmy holding her hand. His had been the last voice she'd heard. It felt odd to come to and find Thomas in his place.

Nevertheless, she was glad to see him.

"Jimmy had to leave but said he'd be back," he told her. Undoing his mask, he leaned over to give her a kiss. "The important thing is, you're doing fantastic and are going to be fine. Dr. Deloram found it amazing, but he thinks they'll get you off the respirator and extubate you by this afternoon. That's a powerful set of lungs you have."

His breath s me I led of toothpaste. Glancing at the drawn curtains around her cubicle as his lips pressed on her cheek, she could tell by the powder blue color that they were in ICU. Obviously he'd gotten over his being barely able to look at her in ER. You aren't afraid of someone catching us? she wanted to ask him, surprised at the intensity of her sudden annoyance with his behavior.

He must have sensed her anger, because he pulled back and studied her, a puzzled look creeping onto his face, only to be dispelled in the flash of a smile. "Hey, I wasn't about to stay away at a time like this, so our secret's out. But who cares? I've been silly about that. Now I want to shout from the rooftops that I love you."

Too little, too late, she would have said if she could, just to make the goof suffer. Even Daisy Mae had her limits.

Then she felt empty inside.

Probably all the drugs they'd given her and everything she'd been through.

He squeezed her hand.

She tried to smile in return, a tough feat around a tube, and drifted back to sleep.

8:35 a.m.

Before SARS hit, at the start of each day Earl had routinely sipped a cappuccino in the privacy of his office and glanced through the morning's New York Herald.

Thanks to his own rules that banned the removal of masks anywhere in ER but the designated lunchroom, he had only the paper now. Without a hit of caffeine to propel him through the headlines, more often than not he leaned back in his chair and stared at his window, the opaque light a reminder that sun and fresh air still existed.

What Janet had said about Stewart hiding in his work bugged him. She hadn't revealed anything the whole hospital didn't already know, but what could be dismissed for over a decade as the quirk of a gifted physician, as long as he performed his daily high-wire act in ICU, had become a flaw demanding a harder look.

Hiding from what? Earl wondered.

An old evasion suggested where the answer might lie.

He leaned forward, picked up his phone, and dialed a 212 exchange that had branded itself on his brain nearly three decades ago.

"New York City Hospital."

"Yes, I wonder if I could speak to the director of clinical research."

"That would be Dr. Cheryl Branagh. One moment please."

The name didn't ring any bells. Good, he thought. NYCH and he had history, big time. He'd probably get further with someone who didn't know him.

Ten minutes later, after talking with a dozen secretaries, an officious female voice said, "Dr. Branagh here."

"Dr. Branagh, my name is Earl Garnet. I'm calling from St. Paul's-"

"I know who you are, Dr. Garnet. There's hardly anyone around here who doesn't. You turned this place inside out a few years back."

Oh, boy, Earl thought. She was referring to a nest of dark secrets he'd uncovered at NYCH while investigating the death of a former classmate. uUh, yes, well, this is entirely another matter-"

Her hearty chuckle interrupted him. "Hey, it needed doing. That makes you a good guy in my book. How can I help today?"

Well, that's a break, he thought. "I don't know if you can. This involves ancient history as well, and has to be kept completely confidential."

"Now I am intrigued."

"We may have a problem with one of our staff members. He's a clinical researcher who came to us in eighty-nine, highly regarded, but I never got a good answer from him as to why he left NYCH."

"You're talking about Stewart."

"Yes. Do you know him?"

That chuckle again.

He liked the sound of it. She came across as open, friendly, straightforward, and cooperative.

"You might say that. I was his second wife."

Oh, Jesus.

More chuckling. "Hey, it took him five years to drive me crazy. Of course, two people working in the same lab should never have married in the first place, but I'm surprised you've lasted this long with him. What's he done?"

Earl wondered if there were ethical proprieties to discussing a physician under investigation with that physician's ex-wife.

After a second's consideration, he decided no, not if he didn't reveal anything, and she did all the talking. "What I need to know is why he left NYCH in the first place. I mean, his credentials were good, but he's always been rather evasive about it, and I wondered if anything irregular had happened there."

No chuckles rolled across the line this time, only the sound of her breathing.

"Look, if you don't feel comfortable talking about this," he said, "perhaps I should speak with someone else."

"It's not that. I may be his ex, but I don't want to hurt him. Is he in trouble?"

Earl weighed his answer. "In a word, yes."

"And what's your part in it?"

"I'm trying to find out if he deserves the trouble he's in."

"Is this to do with some of the chatter I saw on the Internet yesterday about his near-death research? There are rumors going around that he may have been staging events with patients."

"That's part of what I want to find out."

More breathing.

"I know your reputation," she said after a few seconds, "and not just from recent events here. Stewart spoke about you before he left. We were already divorced, yet the guy had no one else to confide in. By then I'd stopped being mad at him all the time, at least enough to feel sorry for him, and we had a young daughter. So for her sake we tried to be civil."

Earl remembered a dark-haired teenage girl who had shown up in Buffalo a few times. Stewart had proudly introduced her around the hospital, but then the visits seemed to peter out. "Yes, I think I met her. Very pretty."

The woman let out an industrial-strength sigh. "I'm not surprised you never heard what happened in eighty-nine. Both the hospital and the medical school hushed it up." She sighed again, the sound more leaden than before, almost closer to a moan.

Earl leaned back in his chair and said nothing. The art of medicine is first and foremost to get people to tell you what's wrong, even when it's painful for them to do so, and his years in ER had made him good at it. He could tell when to prod and when to just listen. Over the phone, unable to see a face, he couldn't be as certain, but what he'd heard conveyed the kind of heavy-layered regret over long-lost dreams that could build up forever. In other words, she might be ripe to unburden herself.

"He left NYCH because a colleague of ours, Jerome Wilcher, committed suicide, and Stewart blamed himself." Another deep breath sounded, ingoing this time. "I wish I could say unjustly so, but I can't. They'd been longtime rivals in the department, and both were after the position of chairman. In the lab, they were equally brilliant, but Stewart outmaneuvered Jerome politically, a combination of being smarter, faster, and more ruthless at that game.

"Also, rumors began to circulate about the integrity of Jerome's experimental data. No hard accusations, just whispers- yet you know how devastating that can be to a scientist's credibility. Jerome had been in charge of research trials at academic centers all over the United States- visited them repeatedly- yet one by one they revoked his appointments and grants. After Stewart became chairman, Jerome lodged several formal complaints against him with the dean, claiming sabotage, but got nowhere. He published less and less, until in the fall of eighty-nine they found him swinging from the water pipes in his lab."

"Good God!"

"In a way, he finally got his accusations against Stewart to stick. Though nobody could prove anything, the dean didn't want Stewart around, in case the story leaked to the press. In exchange for a voluntary resignation, glowing letters of reference would be provided to anyplace that was interested in him."

Son of a bitch. "Is that when you took over the department?" Earl sounded more angry than he intended. But even though it had happened long ago, he despised the kind of smarmy moves by which hospitals passed their problem staff on to other unsuspecting institutions. Would it have changed his own recommendation that St. Paul's take the man? Maybe not. But he didn't like being lied to, not by Stewart, not by a whole administration, and especially not by his alma mater. What made his resentment feel so fresh? That kind of game still went on today, particularly at teaching hospitals, where they valued academic reputations more than truth.

"Down, boy," she said. "Not only didn't I benefit, but I got tarred by his brush, despite the divorce and the fact I'd been publishing before we ever met. They couldn't kick me out, but they made it clear with pointed hints that I could also leave. Nobody likes seeing faces around that remind everyone of how dirty their own research games got. But you know how it is in a center like NYCH: publish enough, and eventually anything can be forgiven, including having married the wrong man. I've been chair for five years."

"Sorry, I didn't mean to take what happened out on you."

"Don't worry. That's all water under a long-ago bridge."

If you say so, he thought, still getting the distinct impression he'd probed old scars that could still hurt. "Why didn't you leave?"

"The best reason in the world- Carol, the daughter you met. A teenager in high school with friends doesn't want to move away."

He couldn't think of anything else to ask and was ready to say goodbye when she added, "I don't think he could do what they're suggesting on the Internet."

"Pardon?"

"Tamper with data."

"Oh? Why?"

"He may be a son of a bitch when it comes to people, but science is like a religion to him. He wouldn't desecrate it."

She had a point. But his original question remained: would Stewart commit murder to save his reputation within that religion? Then, knowing the passions involved, Earl wondered what someone close to a wrongfully disgraced researcher might be willing to do. "This Jerome Wilcher- did he have any family?"

"All I ever knew about him is that he'd been divorced almost a decade earlier- apparently the guy was a womanizer- and his ex-wife didn't come to the funeral. No surprise there. She took him to the cleaners and, from what I heard, kept coming back for more, to the point that he apparently started hiding his assets. They never had kids, his parents were dead, and he had no siblings. There were a few red-eyed women at the service, and from the suspicious way they were eyeing each other I figured they might all have been his former girlfriends. Word had it that one of them actually went home after the service and tried to hang herself as well."

This time Earl remained silent, letting what she had said percolate.

"Why? You thinking somebody set Stewart up, avenging the way he sabotaged Jerome?" she asked after a few seconds.

"It crossed my mind."

"After all these years? I doubt it. Jerome could be an excessively self-obsessed, compulsive scientist, like so many of our breed. Heroes in the lab, losers in the real world, and especially lousy at marriage. However much Jerome's women missed him at the time, nobody I can think of would still care about him that much."

"That's harsh."

"You're probably more acquainted with the crossovers in the research game, the ones who treat people in addition to rats, like Stewart. They have a smattering of human graces. The purists, like Jerome, wilt in sunlight."

"The one who tried to hang herself- you wouldn't happen to remember her name?"

"Sorry."

He thanked her, gave her his numbers- including the private line at home for after hours, suggesting she call him if anything more about Stewart's past came to mind- and hung up.

The thought of someone close to Jerome Wilcher seeking revenge and setting up Stewart still resonated with him, mostly because he hoped it might be true. What a clean and simple way to get Stewart out from under his current trouble. As nasty as he might be, he remained an asset at St. Paul's, whatever had happened at NYCH fourteen years ago. And despite his impossible personality, Earl liked the guy, even wanted the best for him. Because over and above his being a clinical genius, the man still practiced medicine with the same fire in the belly that all doctors start out with but which few keep alive, even the brilliant ones. In that, Earl considered him a kindred spirit.

But as Cheryl Branagh had said, who would feel passionate enough to avenge Jerome Wilcher fourteen years after his death? The woman who'd tried to kill herself over him? No question her feelings were strong at the time, but for that emotion to have persisted until now would seem highly unlikely. One of the other several girlfriends? Even less of a chance. Once they found out about each other they would have been more apt to hate him, not seek revenge for his death. So who else? He'd no immediate family. But sometimes distant relatives could have strong feelings about blood connections.

On a whim he typed the name Wilcher into the staff registry.

Nothing.

What about patients with that name?

He clicked to the admissions page, but no Wilchers were in the hospital at the moment.

Perhaps previously?

According to the patient directory, there never had been.

He dug out the Buffalo phone book to find there weren't any listed in the whole city. A rare name, he thought.

Could there be an avenger with a different name? That he would never find. Oh, well, it had been wishful thinking anyway, and certainly not logical. He'd heard of revenge being a dish best served cold, but to wait fourteen years-

A tap on the door interrupted him.

"Dr. Garnet?" a woman's voice said.

"Yes?"

Even though she wore a mask he recognized her tanned, round face and the corners of eyes that crinkled like fine leather as she stepped into his office.

"Mrs. Baxter," he said without hesitation. Sometimes the person that death left behind stuck with him more than the one it took. Yet something had changed around her eyes. The swollen ripeness of fresh grief had withered into dark hollows, probably due to the aridity of being cried out and the loss of her husband having sunk in. "Come, sit down," he said, rising to his feet. "What can I do for you?"

She stepped over to the chair opposite him. When she settled in, it seemed far too big for her.

"How are you doing?"

Most people at this stage just said, "Fine," and rushed to tell him what they wanted, being in no state to let feelings interfere with the endless paperwork that went with death.

But she hesitated, and he knew he would get a truthful answer.

"It's hard," she said. "Really hard."

She looked down at her hands, and the silence created a divide between him and her.

"I have to say you were magnificent at your husband's side when he died," he said, attempting to close it. "The kind of strength and self-control it took to say good-bye the way you did is rare."

"I loved him." She spoke without looking up.

The silence settled in again.

"Do you have family here?"

"Oh, yes. My sister."

"Children?"

"No. We never…" Her eyes glistened, but no tears fell. "In a way, it's a blessing. What could be harder than to tell a little boy or girl why Daddy's gone, right? Hell, I can barely take care of myself."

Earl nodded sympathetically, having heard the same rationale a thousand times from childless survivors. Inside he would invariably wince and once more thank the fates for the joy of having Brendan and his soon-to-arrive little brother as part of his life with Janet. He would endure any pain for having had that treasure.

"And of course there's no one who explains to me why my husband's gone," she added, her lids narrowing like gun slits. "I mean, there's a lot of assholes left walking around out there. Why'd it have to be him?"

Her glare dared him to try and give an answer.

He shook his head and, gesturing skyward with his palms, referred her question to the heavens.

She sighed as if to say, Spare me the fools. "I do appreciate what you did for Artie, and your kindness toward me," she added, as if that at least compensated in part for his current failing to tell her what she needed to know.

"I wish I could have helped him more."

She reached inside her handbag and pulled out a business envelope bearing the logo of a well-known insurance company. "I'm sorry to bother you with these. Dr. Popovitch filled out the initial forms, but he's not here, and they just require a confirmation of his initial report. Do you mind?"

He hated insurance papers. Most of the time the questions attempted to derail the claim and demanded irrelevant details that had more to do with filling in squares than providing an informed medical opinion as to the cause of death. And if the doctor who'd actually handled the case happened to be off duty when the family showed up with the documents, a frequent occurrence, Michael, bless his soul, had mostly taken over the mind-numbing chore. But occasionally one still got through to Earl. "Sure, I'd be glad to," he said, taking the papers out of her hand.

"Thanks. You don't know what a relief it is getting them out of the way. I thought there might be trouble, and Lord knows I need the money. But Dr. Popovitch assured me everything should go through fine. And thank God. It's a terrible thing to say, but that policy's the only good investment Artie made since the bubble popped."

He got the message. She expected him to be as helpful as Michael had been. He started to skim through what he'd written.

Five minutes later he wished he hadn't.

"Michael, we have to talk."

Earl had phoned him at home the instant Mrs. Baxter left his office.

"Jesus, Earl, can't it wait? You know I just got off a shift from hell."

"I just had an interesting conversation with Artie Baxter's widow about insurance papers."

Silence reigned supreme.

"Where?" Michael asked after a few seconds.

Earl thought of the nearest place outside the hospital to get a cup of coffee. "The Horseshoe Bar."

A copper haze from the morning rush hour lingered over Buffalo, staining the previously blue sky a color of rust. He made the ten-minute walk in five, despite the temperature having already climbed past the predicted high. Ducking inside a front door of smoked glass to the dark air-conditioned interior provided welcome relief. A former hangout for gangs and druggies, the place had mellowed into a respectable watering hole where many of the staff and medical residents gathered for a beer after work. The change had been helped along by a makeover with mirrors, plants, and several coats of dark green paint, but no amount of interior decorating could erase Earl's memory of the kids whom he'd pronounced dead after they'd OD'd here.

Over the last three months the management, in another adjustment to the times, had started to serve an early-bird breakfast, taking advantage of hospital staff determined to avoid the designated eating areas of a SARS environment. That crowd would be long gone to work, he'd figured.

His eyes adjusted to the dark. Sure enough, most of the tables and booths stood empty, and a long chrome-trimmed bar, gleaming under the neon glow of a large, red-script Budweiser sign, wouldn't open until the lunch rush arrived a few hours from now. But the aroma of fresh coffee filled the air.

He chose a corner table and had downed two cups by the time Michael slid into the seat opposite him.

"So what's the deal?" Earl said without ceremony.

"Artie Baxter died of a cardiac arrest. You were there. That's what it says on the form."

"You didn't mention the fact he came in unconscious from hypoglycemia."

"That's not the cause of death."

"It's the cause of the cause, Michael. Don't kid around with me."

He shrugged. "That could be one opinion."

"Well, here's another. That story of his, that he took his normal dose of insulin, then got too busy to eat, stank like three-day-old fish. I think he deliberately tried to check out, using insulin. As to why, I don't know for sure, but I bet you do. Mrs. Baxter is pretty forthright about Artie's lousy investment skills. So what happened? He became suicidal after getting in over his head with the stock market? And you hid that little fact so a pretty young widow could still collect his insurance?"

Michael's expression hardened. "Her being pretty had nothing to do with it."

"Oh, yeah? Then where were you Monday night? Not ER, where Donna said you'd be." On the fly, he decided to take a big leap, in the hope of provoking an outburst of truth. "What's going on, Michael? You into consoling widows?"

Michael's face reddened until it resembled a beet with a beard. "If you weren't my friend…" He clenched his fist. "Just stay out of this, Earl. It's not what you think."

"Then change my thinking."

Michael exhaled, the way he'd done in his smoking days, as if intent on expelling the last traces of air in his lungs. His fingers uncoiled. "She needed the money. It's not her fault her husband tried to check out. And he did have chest pain that he ignored, like a lot of men we see who don't make it, and they still get the insurance. So Where's the harm?"

"It's fraud. If that company asks to see the original chart-"

"They'll see my note that describes exactly what happened in ER. An insulin-dependent diabetic male arrives comatose, receives glucose, wakes up, arrests, and dies. Wife says he'd been complaining for days of chest pain that he blamed on indigestion- amen. And not a fraudulent statement anywhere."

"What if they ask you why you didn't mention the coma on the insurance claim? And if they also read the nurses' notes, they'll see that cockamamie story of his about the insulin. Just because you didn't spell it out doesn't mean they won't put it together, just like we did."

"Bullshit. Once they get a doctor's signature, they never ask for nursing notes unless they suspect something's not kosher."

"What do you mean never? You've done this before?"

"Of course not."

But he'd taken a second too long in answering.

"Have you ever had an insurance company challenge your ruling on a cause of death, let alone go so far as to demand nurses' notes for corroboration?" he asked, barely skipping a beat.

No, he hadn't. But Earl couldn't shake the feeling of being fed a lie.

"And don't tell me you never fudged a form," Michael continued. "Left out a detail that might have torpedoed a claim, stood over a corpse that had tobacco-stained fingers and ticked the 'don't know' box in answer to the question 'Has patient smoked in the last year?'"

Again Earl couldn't disagree. Every doctor knew the drill: don't outright lie, but don't hand the adjusters an outright gift either. What made this case dirty was the blatancy of the omission and if the doctor got any favors in return.

Michael stood up to leave. "So we're square?" he said, as if the matter were closed. "Now I'm going home to sleep."

Earl decided to try a more delicate approach. "You look as if you haven't had a good rest in months, Michael. Something's been eating you up- has been for a while now- and don't tell me again that it's just that you're tired or worried about SARS. Even when we get together for dinner or take the kids out somewhere, there are moments when you get a look in your eyes that's a million miles away. Hell, I've even seen Terry looking at you funny, wondering what's wrong. And you wouldn't have come all the way down here if this thing with Artie Baxter's insurance form was as innocent as you claim. So let's cut the bullshit. I want to know what's going on."

His friend leaned on the back of the chair he'd just vacated and towered over Earl. "You know, I liked you better when you were just chief of ER and mad at everyone else who ran the place."

"This place? The Horseshoe?"

Michael laughed. The smile looked good on him, and for a few seconds the craggy landscape of his face softened. Then he leaned closer, grinned wider, and his expression hardened. "Since they made you VP, medical, you've been getting in more trouble than ever. Oh, excuse me, make that suspended VP, medical."

"This isn't about me, Michael."

His grin vanished. "It sure is. Because I'm betting my good friend Earl won't go around making accusations about me and widows that would upset the hell out of my wife. And for my good friend's information, SARS is why I'm losing sleep. It's wrecking the shit out of my marriage. Donna's so scared I'll bring it home to Terry, she's thinking of moving to her mother's with him. So I'm also counting on my good friend to give his long-trusted pal Michael the benefit of the doubt and not pry into matters that are best left alone. Now I'm going back home to bed." He started toward the door.

"Michael, damn it, you can't do this to me." Earl threw a few dollars on the table and ran after him. "Tell me what the hell you've gotten into-"

Michael spun around and jabbed an index finger that felt like an iron pipe into Earl's chest. "Something that needs doing, understand! For God's sake, harness that righteous bloodhound streak of yours and quit fucking with the good guys!"

Stung, Earl took a step back. "The good guys?"

"Yeah. The ones whom you've seen fit to rag lately. Stewart, now me, even Father Jimmy."

"Jimmy told you that?"

Michael nodded. "Trust me, you don't want to pursue any of it."

"What the hell are you talking about?"

He opened his mouth to reply, seemed to think better of it, and turned toward the exit, walking stiffly, his shoulders rigid. At the blackened doors he paused and peered back at Earl. "Just remember, we're all trying to do our best." Transient as a blink, the bulky posture of Michael's upper body bunched up and reminded Earl of an animal, hunched over and about to charge, warning off an intruder. It looked so out of character that Michael might have been some stranger standing there. Then he was gone.