February seventeenth was a fateful day for Sam Flemming.

Sam considered himself an extremely lucky person. As a broker far one of the major Wall Street firms, he’d become wealthy by the age of forty-six. Then, like a gambler who knew when to quit, Sam had taken his earnings and fled north from the concrete canyons of New York to idyllic Bartlet, Vermont. There he’d begun to do what he’d always wanted to do: paint.

Part of Sam’s good fortune had always been his health, yet at half past four on February seventeenth, something strange began to happen. Numerous water molecules within many of his cells began to split apart into two fragments: a relatively inoffensive hydrogen atom and a highly reactive, viciously destructive hydroxyl free radical.

As these molecular events transpired, Sam’s cellular defenses were activated. But on this particular day those defenses against free radicals were quickly exhausted; even the antioxidant vitamins E, C, and beta carotene which he diligently took each day could not stem the sudden, overwhelming tide.

The hydroxyl free radicals began to nibble away at the core of Sam Flemming’s body. Before long, the cell membranes of the affected cells began to leak fluid and electrolytes. At the same time some of the cells’ protein enzymes were cleaved and inactivated. Even many DNA molecules were assaulted, and specific genes were damaged.

In his bed at Bartlet Community Hospital, Sam remained unaware of the high-stakes molecular battle within his cells. What he did notice was some of its sequelae: an elevation of his temperature, some digestive rumblings, and the beginnings of chest congestion.

Later that afternoon when Sam’s surgeon, Dr. Portland, came in to see him, the doctor noted Sam’s fever with disappointment and alarm. After listening to Sam’s chest, Dr. Portland tried to tell Sam that a complication had apparently set in. Dr. Portland said that a touch of pneumonia was interfering with Sam’s otherwise smooth recovery from the operation to repair his broken hip. But by then Sam had become apathetic and mildly disoriented. He didn’t understand Dr. Portland’s report on his status. The doctor’s prescription for antibiotics and his assurances of a rapid recovery failed to register with him.

Worse still, the doctor’s prognosis proved wrong. The prescribed antibiotic failed to stop the developing infection. Sam never recovered enough to appreciate the irony that he’d survived two muggings in New York City, a commuter plane crash in Westchester County, and a bad four-vehicle accident on the New Jersey Turnpike, only to die from complications arising from a fall on a patch of ice in front of Staley’s Hardware Store on Main Street, Bartlet, Vermont.

Standing before Bartlet Community Hospital’s most important employees, Harold Traynor paused long enough to relish the moment. He’d just called the meeting to order. The group assembled—all heads of departments—had obediently fallen silent. All eyes were riveted on him. Traynor’s dedication to his office as chairman of the hospital board was a point of pride. He savored moments such as this when it became clear his very presence inspired awe.

“Thank you all for coming out on this snowy evening. I’ve called this meeting to impress upon you how seriously the hospital board is taking the unfortunate assault on Nurse Prudence Huntington in the lower parking lot last week. The fact that the rape was thwarted by the serendipitous arrival of a member of the hospital security staff does not in any way lessen the seriousness of the offense.”

Traynor paused, his eyes falling significantly on Patrick Swegler. The head of hospital security averted his gaze to avoid Traynor’s accusatory glance. The attack on Miss Huntington had been the third such episode in the last year, and Swegler felt understandably responsible.

“These attacks must be stopped!” Traynor looked to Nancy Widner, the director of nursing. All three victims had been nurses under her supervision.

“The safety of our staff is a prime concern,” Traynor said as his eyes jumped from Geraldine Polcari, head of dietary, to Gloria Suarez, head of housekeeping. “Consequently, the executive board has proposed the construction of a multi-storied parking facility to be built in the area of the lower parking lot. It will be directly attached to the main hospital building and will contain appropriate lighting and surveillance cameras.”

Traynor gave Helen Beaton, president of the hospital, a nod. On his cue, Beaton lifted a cloth from the conference table to reveal a detailed architectural model of the existing hospital complex as well as the proposed addition: a massive, three-story structure protruding from the rear of the main building.

Amid exclamations of approval, Traynor stepped around the table to position himself next to the model. The hospital conference table was often a repository for medical paraphernalia under consideration for purchase. Traynor reached over to remove a rack of funnel-shaped test tubes so that the model could be better seen. Then he scanned his audience. All eyes were glued to the model; everyone except Werner Van Slyke had gotten to his feet.

Parking had always been a problem at Bartlet Community Hospital, especially in inclement weather. So Traynor knew that his proposed addition would be popular even before the recent string of attacks in the lower lot. He was pleased to see that his unveiling was progressing as successfully as he’d anticipated. The room was aglow with enthusiasm. Only sullen Van Slyke, the head of engineering and maintenance, remained impassive.

“What’s the matter?” Traynor asked. “Doesn’t this proposal meet with your approval?”

Van Slyke looked at Traynor, his expression still vacant.

“Well?” Traynor felt himself tense. Van Slyke had a way of irritating him. Traynor had never liked the man’s laconic, unemotional nature.

“It’s okay,” Van Slyke said dully.

Before Traynor could respond the door to the conference room burst open and slammed against its stop on the floor. Everyone jumped, especially Traynor.

Standing in the doorway was Dennis Hodges, a vigorous, stocky seventy-year-old with rough-hewn features and weathered skin. His nose was rosy and bulbous, his beady eyes rheumy. He was dressed in a dark green boiled wool coat over creaseless corduroy trousers. On top of his head was a red plaid hunter’s cap dusted with snow. In his raised left hand he was clutching a sheaf of papers.

There was no doubt Hodges was angry. He also smelled strongly of alcohol. His dark, gun-barrel-like eyes strafed the gathering, then trained in on Traynor.

“I want to talk to you about a few of my former patients, Traynor. You too, Beaton,” Hodges said, throwing her a quick, disgusted look. “I don’t know what kind of hospital you think you’ve been running here, but I can tell you I don’t like it one bit!”

“Oh, no,” Traynor muttered as soon as he’d recovered from Hodges’ unexpected arrival. Irritation quickly overtook his shock. A rapid glance around the room assured him that the others were about as happy to see Hodges as he was.

“Dr. Hodges,” Traynor began, forcing himself to be civil. “I think it is quite apparent that we are having a meeting here. If you will excuse us  .  .  .”

“I don’t care what the hell you people are doing,” Hodges snapped. “Whatever it is, it pales in respect to what you and the board have been up to with my patients.” He stalked toward Traynor. Instinctively, Traynor leaned back. The smell of whiskey was intense.

“Dr. Hodges,” Traynor said with obvious anger. “This is not the time for one of your interruptions. I’ll be happy to meet with you tomorrow to talk about your grievances. Now if you will kindly leave and let us get on with our business  .  .  .”

“I want to talk now!” Hodges shouted. “I don’t like what you and your board are doing.”

“Listen, you old fool,” Traynor snapped. “Lower your voice! I have no earthly idea what is on your mind. But I’ll tell you what I and the board have been doing: we’ve been breaking our necks in the struggle to keep the doors of this hospital open, and that’s no easy task for any hospital in this day and age. So I resent any implication to the contrary. Now be reasonable and leave us to our work.”

“I ain’t waiting,” Hodges insisted. “I’m talking to you and Beaton right now. Nursing, dietary, and housekeeping nonsense can wait. This is important.”

“Ha!” Nancy Widner said. “It’s just like you, Dr. Hodges, bursting in here and suggesting that nursing concerns aren’t important. I’ll have you know  .  .  .”

“Hold on!” Traynor said, extending his hands in a conciliatory gesture. “Let’s not get into a free-for-all. The fact of the matter is, Dr. Hodges, we are here talking about the rape attempt that occurred last week. I’m sure you are not suggesting that one rape and two attempted rapes by a man in a ski mask are not important.”

“It’s important,” Hodges agreed, “but not as important as what’s on my mind. Besides, the rape problem is obviously an in-house affair.”

“Just one second!” Traynor demanded. “Are you implying that you know the identity of the rapist?”

“Let’s put it this way,” Hodges said. “I have my suspicions. But right now I’m not interested in discussing them. I’m interested in these patients.” For emphasis he slammed the papers he’d been holding onto the table.

Helen Beaton winced and said: “How dare you come charging in here as if you own the place, telling us what is important and what isn’t. As administrator emeritus that’s hardly your role.”

“Thank you for your uninvited advice,” Hodges said.

“All right, all right,” Traynor sighed with frustration. His meeting had dissolved into a verbal melee. He picked up Hodges’ papers, thrust them into the man’s hand, then escorted the doctor from the room. Hodges resisted initially, but ultimately let himself be ushered out.

“We’ve got to talk, Harold,” Hodges said once they were in the hall. “This is serious stuff.”

“I’m sure it is,” Traynor said, trying to sound sincere. Traynor knew that at some point he’d have to hear Hodges’ grievances. Hodges had been the hospital administrator back when Traynor was still in grammar school. Hodges had taken the position when most doctors hadn’t been interested in the responsibility. In his thirty years at the helm, Hodges had built Bartlet Community Hospital from a small rural hospital to a true tertiary care center. It was this sprawling institution he’d passed on to Traynor when he’d stepped down from his position three years before.

“Look,” Traynor said, “whatever is on your mind, it can surely wait until tomorrow. We’ll talk at lunch. In fact, I’ll arrange for Barton Sherwood and Dr. Delbert Cantor to join us. If what you want to discuss concerns policy, which I assume it does, then it would be best to have the vice chairman and the chief of the professional staff there as well. Don’t you agree?”

“I suppose,” Hodges admitted reluctantly.

“Then it’s settled,” Traynor said soothingly, eager to get back and salvage what he could of his meeting now that Hodges was placated for the time being. “I’ll contact them tonight.”

“I might not be administrator any longer,” Hodges added, “but I still feel responsible for what goes on around here. After all, if it hadn’t been for me you wouldn’t have been named to the board, much less elected chairman.”

“I understand that,” Traynor said. Then he joked: “But I don’t know whether to thank you or curse you for this dubious honor.”

“I’m worried you’ve let the power go to your head,” Hodges said.

“Oh, come on!” Traynor said. “What do you mean, ‘power’? This job is nothing but one headache after another.”

“You’re essentially running a hundred-million-dollar entity,” Hodges said. “And it’s the largest employer in this whole part of the state. That means power.”

Traynor laughed nervously. “It’s still a pain in the neck. And we’re lucky to be in business. I don’t have to remind you that our two competitors no longer are. Valley Hospital closed, and the Mary Sackler has been turned into a nursing home.”

“We might still be open, but I’m afraid you money men are forgetting the hospital’s mission.”

“Oh, bullcrap!” Traynor snapped, losing a bit of control. “You old docs have to wake up to a new reality. It’s not easy running a hospital in the current environment of cost-cutting, managed care, and government intervention. It isn’t cost-plus anymore like you had it. Times have changed, demanding new adaptations and new strategies for survival. Washington is mandating it.”

Hodges laughed derisively: “Washington sure isn’t mandating what you and your cohorts are doing.”

“The hell they aren’t,” Traynor argued. “It’s called competition, Dennis. Survival of the fittest and the leanest. No more sleight-of-hand cost-shifting like you used to get away with.”

Traynor paused, realizing that he was losing his composure. He wiped away the perspiration that had broken out on his forehead. He took a deep breath. “Listen, Dennis, I’ve got to get back into the conference room. You go home, calm down, relax, get some sleep. We’ll get together tomorrow and go over whatever is on your mind, okay?”

“I am a bit tuckered,” Hodges admitted.

“Sure you are,” Traynor agreed.

“Tomorrow for lunch? Promise? No excuses?”

“Absolutely,” Traynor said as he gave Hodges a prodding pat on the back. “At the inn at twelve sharp.”

With relief Traynor watched his old mentor trudge toward the hospital lobby with his distinctive lumbering gait, rocking on his hips as if they were stiff. Turning back toward the conference room, Traynor marveled at the man’s uncanny flair for causing turmoil. Unfortunately, Hodges was going beyond being a nuisance. He was becoming a virtual albatross.

“Can we have some order here,” Traynor called out over the bedlam to which he returned. “I apologize for the interruption. Unfortunately, old Doc Hodges has a particular knack for showing up at the most inopportune times.”

“That’s an understatement,” Beaton said. “He’s forever barging into my office to complain that one of his former patients isn’t getting what he considers VIP treatment. He acts as if he’s still running this place.”

“The food is never to his liking,” Geraldine Polcari complained.

“Nor is the room cleaning,” added Gloria Suarez.

“He comes into my office about once a week,” Nancy Widner said. “It’s always the same complaint. The nurses aren’t responding quickly enough to his former patients’ requests.”

“He’s their self-elected ombudsman,” Beaton said.

“They’re the only people in the town that can stand him,” Nancy said. “Just about everyone else thinks he’s a crotchety old coot.”

“Do you think he knows the identity of the rapist?” Patrick Swegler asked.

“Heavens, no,” Nancy said. “The man’s just a blowhard.”

“What do you think, Mr. Traynor?” Patrick Swegler persisted.

Traynor shrugged. “I doubt he knows anything, but I’ll certainly ask when I meet with him tomorrow.”

“I don’t envy you that lunch,” Beaton said.

“I’m not looking forward to it,” Traynor admitted. “I’ve always felt he deserved a certain amount of respect, but to be truthful my resolve is wearing a bit thin.

“Now, let’s get back to the matter at hand.” Traynor soon had the meeting back on track, but for him the joy of the evening had been lost.

Hodges trudged straight up Main Street in the middle of the road. For the moment there were no vehicles moving in either direction. The plows hadn’t come through yet; two inches of powdery new snow blanketed the town as still more flakes fell.

Hodges cursed under his breath, giving partial vent to his unappeased anger. Now that he was on his way home he felt angry for having allowed Traynor to put him off.

Coming abreast of the town green with its deserted, snow-covered gazebo, Hodges could see north past the Methodist church. There, in the distance, directly up Front Street, he could just make out the hospital’s main building. Hodges paused, gazing wistfully at the structure. A sense of foreboding descended over him with a shiver. He’d devoted his life to the hospital so that it would serve the people of the town. But now he feared that it was faltering in its mission.

Turning away, Hodges recommenced his trek up Main Street. He jammed the copy-machine papers he was holding into his coat pocket. His fingers had gone numb. Half a block farther he stopped again. This time he gazed at the mullioned windows of the Iron Horse Inn. A beckoning, incandescent glow spilled out onto the frigid, snow-covered lawn.

It only took a moment of rationalization for Hodges to decide he could use another drink. After all, now that his wife, Clara, spent more time with her family in Boston than she did with him in Bartlet, it wasn’t as if she’d be waiting up for him. There were certainly some advantages to their virtual estrangement. Hodges knew he would be glad for the extra fortification for the twenty-five-minute walk he faced to get home.

In the outer room Hodges stomped the snow from his rubber-soled workboots and hung up his coat on a wooden peg. His hat went into a cubbyhole above. Passing an empty coat-check booth used for parties, Hodges went down a short hallway and paused at the entryway of the bar.

The room was constructed of unfinished pine that had an almost charred look from two centuries of use. A huge fieldstone fireplace with a roaring fire dominated one wall.

Hodges scanned the chamber. From his point of view, the cast of characters assembled was unsavory, hardly reminiscent of NEC’s “Cheers.” He saw Barton Sherwood, the president of the Green Mountain National Bank, and now, thanks to Traynor, vice chairman of the hospital’s board of directors. Sherwood was sitting in a booth with Ned Banks, the obnoxious owner of the New England Coat Hanger Company.

At another table, Dr. Delbert Cantor was sitting with Dr. Paul Darnell. The table was laden with beer bottles, baskets of potato chips, and platters of cheese. To Hodges they looked like a couple of pigs at the trough.

For a split second Hodges thought about pulling his papers from his coat and getting Sherwood and Cantor to sit down and talk with him. But he abandoned the idea immediately. He didn’t have the energy and both Cantor and Darnell hated his guts. Cantor, a radiologist, and Darnell, a pathologist, had both suffered when Hodges had arranged for the hospital to take over those departments five years earlier. They weren’t likely to be a receptive audience for his complaints.

At the bar stood John MacKenzie, another local Hodges would just as soon avoid. Hodges had had a long-standing disagreement with the man. John owned the Mobil station out near the interstate and had serviced Hodges’ vehicles for many years. But the last time he’d worked on Hodges’ car, the problem had not been fixed. Hodges had had to drive all the way to the dealership in Rutland to get it repaired. Consequently he’d never paid John.

A couple of stools beyond John MacKenzie, Hodges saw Pete Bergan, and he groaned inwardly. Pete had been a “blue baby” who’d never finished the sixth grade. At age eighteen he dropped out of school and supported himself by doing odd jobs. Hodges had arranged for his job helping the hospital grounds crew but had had to acquiesce to his firing when he proved too unreliable. Since then Pete had held a grudge.

Beyond Pete stretched a row of empty bar stools. Beyond the bar and down a step were two pool tables. Music thudded out of an old-fashioned fifties-style jukebox against the far wall. Grouped around the pool tables were a handful of students from Bartlet College, a small liberal arts institution that had recently gone coed.

For a moment Hodges teetered on the threshold, trying to decide if a drink was worth crossing paths with any of these people. In the end the memory of the cold and the anticipation of the taste of the scotch propelled him into the room.

Ignoring everyone Hodges went to the far end of the bar and climbed up on an empty stool. The radiant heat from the fire warmed his back. A tumbler appeared in front of him, and Carleton Harris, the overweight bartender, poured him a glass of Dewar’s without ice. Carleton and Hodges had known each other for a long time.

“I think you’ll want to find another seat,” Carleton advised.

“Why’s that?” Hodges asked. He’d been pleased that no one had noticed his entrance.

Carleton nodded at a half-empty highball glass on the bar two stools away. “I’m afraid our fearless chief of police, Mr. Wayne Robertson, has stopped in for a snort. He’s in the men’s room.”

“Oh, damn!” Hodges said.

“Don’t say I didn’t warn you,” Carleton added as he headed toward several students who’d approached the bar.

“Hell, it’s six of one, half a dozen of the other,” Hodges murmured to himself. If he moved to the other end, he’d have to face John MacKenzie. Hodges decided to stay where he was. He lifted his glass to his lips.

Before he could take a drink, Hodges felt a slap on his back. It was all he could do to keep his drink from clanking against his teeth and spilling.

“Well, if it isn’t the Quack!”

Swinging around, Hodges glared into the inebriated face of Wayne Robertson. Robertson was forty-two and heavyset. At one time he’d been all muscle. Now he was half muscle and half fat. The most prominent aspect of his profile was his abdomen, which practically draped his official belt buckle. Robertson was still in uniform, gun and all.

“Wayne, you’re drunk,” Hodges said. “So why don’t you just go home and sleep it off.” Hodges turned back to the bar and tried once more to take a sip of his drink.

“There’s nothing to go home to, thanks to you.”

Hodges slowly turned around again and looked at Robertson. Robertson’s eyes were red, almost as red as his fat cheeks. His blond hair was clipped short in a fifties-style butch.

“Wayne,” Hodges began, “we’re not going over this again. Your wife, rest her soul, was not my patient. You’re drunk. Go home.”

“You were running the freakin’ hospital,” Robertson said.

“That doesn’t mean I was responsible for every case, you lunkhead,” Hodges said. “Besides, it was ten years ago.” He again tried to turn away.

“You bastard!” Robertson snarled. Reaching out, he grabbed Hodges’ shirt at the collar and tried to lift Hodges off the barstool.

Carleton Harris came around the bar with a swiftness that belied his bulk and insinuated himself between the two men. He opened Robertson’s grip on Hodges’ shirt one finger at a time. “Okay, you two,” he said. “Off to your own corners. We don’t allow sparring here at the Iron Horse.”

Hodges straightened his shirt indignantly, snatched up his drink, and walked to the other end of the bar. As he passed behind John MacKenzie he heard the man mutter: “Deadbeat.” Hodges refused to be provoked.

“Carleton, you shouldn’t have interfered,” Dr. Cantor called out to the bartender. “If Robertson had blown old Hodges away half the town would have cheered.”

Dr. Cantor and Dr. Darnell laughed uproariously at Cantor’s comment. Each one encouraged the other until they were slapping their knees and choking on their beers. Carleton ignored them as he stepped around the bar to help Barton Sherwood who’d approached for refills.

“Dr. Cantor’s right,” Sherwood said loud enough for everyone in the bar to hear. “Next time Hodges and Robertson face off, leave them be.”

“Not you too,” Carleton said as he deftly mixed Sherwood’s drinks.

“Let me tell you about Dr. Hodges,” Sherwood said, still loud enough for everyone to hear. “A good neighbor he isn’t. By a historical accident he owns a little tongue of land that happens to separate my two lots. So what does he do? He builds this gigantic fence.”

“Of course I fenced that land,” Hodges called out, unable to hold his tongue. “It was the only way to keep your goddamn horses from dropping their shit all over my property.”

“Then why not sell the strip of land?” Sherwood demanded, turning to face Hodges. “It’s of no use to you.”

“I can’t sell it because it’s in my wife’s name,” Hodges answered.

“Nonsense,” Sherwood said. “The fact that your house and land are in your wife’s name is merely a legacy of an old ruse to protect your assets from any malpractice judgment. You told me so yourself.”

“Then perhaps you should know the truth,” Hodges said. “I was trying to be diplomatic. I won’t sell you the land because I despise you. Is that easier for your pea brain to comprehend?”

Sherwood turned to the room and addressed everyone present. “You’re all witnesses. Dr. Hodges is admitting he’s acting out of spite. No surprise, of course, and hardly a Christian attitude.”

“Oh, shut up,” Hodges retorted. “It’s a bit hypocritical for a bank president to question someone else’s Christian ethics with all the foreclosures on your conscience. You’ve put families out of their homes.”

“That’s different,” Sherwood said. “That’s business. I have my stockholders to consider.”

“Oh, bull,” Hodges said with a wave of dismissal.

A sudden commotion at the door caught Hodges’ attention. He turned in time to see Traynor and the rest of the attendees of the hospital meeting troop into the bar. He could tell that Traynor was not at all pleased to see him. Hodges shrugged and turned back to his drink. But he couldn’t dismiss the fortuitous fact that all three principals were there: Traynor, Sherwood, and Cantor.

Grabbing his whiskey, Hodges slipped off his stool and followed Traynor to Sherwood and Banks’s table. Hodges tapped him on his shoulder.

“How about talking now?” Hodges suggested. “We’re all here.”

“Goddamn it, Hodges,” Traynor blurted out. “How many times do I have to tell you? I don’t want to talk tonight. We’ll talk tomorrow!”

“What does he want to talk about?” Sherwood asked.

“Something about a few of his old patients,” Traynor said. “I told him that we’d meet him for lunch tomorrow.”

“What’s going on?” Dr. Cantor asked, joining the fray. He’d sensed blood and had been drawn over to the table like a shark attracted to chum.

“Dr. Hodges isn’t happy with the way we are running the hospital,” Traynor said. “We’re to hear about it tomorrow.”

“No doubt the same old complaint,” Sherwood interjected. “No VIP treatment for his old patients.”

“Some gratitude!” Dr. Cantor said, interrupting Hodges who’d tried to respond. “Here we are donating our time pro bono to keep the hospital afloat and what do we get in return: nothing but criticism.”

“Pro bono my ass,” Hodges sneered. “None of you fool me. Your involvement isn’t charity. Traynor, you’ve come to use the place to support your newly discovered grandiosity. Sherwood, your interest isn’t even that sophisticated. It’s purely financial, since the hospital is the bank’s largest customer. And Cantor, yours is just as simple. All you’re interested in is the Imaging Center, that joint venture I allowed in a moment of insanity. Of all the decisions I made as hospital administrator, that’s the one I regret the most.”

“You thought it was a good deal when you made it,” Dr. Cantor said.

“Only because I thought it was the only way to update the hospital’s CAT scanner,” Hodges said. “But that was before I realized the machine would pay for itself in less than a year which, of course, made me realize you and the other private radiologist were robbing the hospital of money it should have been earning.”

“I’m not interested in opening this old battle,” Dr. Cantor said.

“Nor am I,” Hodges agreed. “But the point is there’s little or no charity involved with you people. Your concern is financial gain, not the good of your patients or the community.”

“You’re no one to talk,” Traynor snapped. “You ran the hospital like a personal fiefdom. Tell us who’s been taking care of that house of yours all these years?”

“What do you mean?” Hodges stammered, his eyes darting back and forth among the men in front of him.

“It’s not a complicated question,” Traynor said, his anger driving him on. He’d stuck Hodges with a knife and now he wanted to push it in to the hilt.

“I don’t know what my house has to do with this,” Hodges managed.

Traynor went up on his toes to survey the room. “Where’s Van Slyke?” he asked. “He’s here somewhere.”

“He’s by the fire,” Sherwood said, pointing. He had to struggle to suppress a contented smile. This issue about Hodges’ house had nettled him for some time. The only reason he’d never brought it up was because Traynor had forbidden it.

Traynor called to Van Slyke, but the man didn’t seem to hear. Traynor called again, this time loud enough for everyone in the bar to hear. Conversation stopped. Except for the music emanating from the jukebox, the room was momentarily silent.

Van Slyke moved slowly across the room, uncomfortable in the spotlight. He was aware most of the people were watching him. But they soon lost interest and conversations recommenced where they had left off.

“Good grief, man,” Traynor said to Van Slyke. “You look like you’re moving through molasses. Sometimes you act eighty years old instead of thirty.”

“Sorry,” Van Slyke said, maintaining his bland facial expression.

“I want to ask you a question,” Traynor continued. “Who has been taking care of Dr. Hodges’ house and property?”

Van Slyke looked from Traynor to Hodges, a wry smile curling on his lips. Hodges looked away.

“Well?” Traynor questioned.

“We have been,” Van Slyke said.

“Be a little more specific,” Traynor said. “Who is ‘we’?”

“The hospital grounds crew,” Van Slyke said. He didn’t take his eyes off Hodges. Nor did his smile change.

“How long has this been going on?” Traynor asked.

“Since way before I arrived,” Van Slyke said.

“It’s going to stop as of today,” Traynor said. “Understand?”

“Sure,” Van Slyke said.

“Thank you, Werner,” Traynor said. “Why don’t you go over to the bar and have a beer while we finish chatting with Dr. Hodges.” Van Slyke returned to his place by the fire.

“You know that old expression,” Traynor said, “ ‘People in glass houses  .  .  .’  ”

“Shut up!” Hodges snapped. He started to say something else but stopped himself. Instead he stalked from the room in a fit of frustrated anger, grabbed his coat and hat, and plunged out into the snowy night.

“You old fool,” Hodges muttered as he headed south out of town. He was furious at himself for allowing a “perk” to derail momentarily his indignation about patient care. Yet it was true that hospital maintenance had been taking care of his grounds. It had started years ago. The crew had simply shown up one day. Hodges had never asked for the service, but he’d never done anything to stop it, either.

The long walk home in the frosty night helped dampen Hodges’ guilt about the yard service. After all, it didn’t have anything to do with patient care. As he turned into his unplowed driveway he resolved to offer to pay some reasonable figure for the services rendered. He wasn’t about to allow this affair to stifle his protest about more serious matters.

When Hodges reached the midpoint of his long driveway he could see down into the lower meadow. Through the blowing snow he could just make out the fence that he’d erected to keep Sherwood’s horses from crossing his property. He’d never sell that strip of land to that bastard. Sherwood had gotten the second piece of land on a foreclosure of a family whose breadwinner had been one of Hodges’ patients. In fact, he was one of the patients whose hospital admission summary Hodges had in his pocket.

Leaving the driveway, Hodges took a shortcut that skirted the frog pond. He could tell some of the neighborhood kids had been skating because the snow had been pushed off the ice and a makeshift hockey goal had been erected. Beyond the pond Hodges’ empty house loomed out of the snowy darkness.

Rounding the building, Hodges approached the side door of the clapboard addition that connected the house with the barn. He knocked the snow off his boots and entered. In the mud room he removed his coat and hat and hung them up. Fumbling in his coat pocket he pulled out the papers he’d been carrying and took them into the kitchen.

After placing the papers on the kitchen table, Hodges headed for the library to pour himself a drink in lieu of the one he’d abandoned at the inn. Insistent knocking at his door stopped him midway across the dining room.

Hodges looked at his watch in puzzlement. Who could be calling at that hour and on such a night? Reversing his direction, he went back through the kitchen and into the mud room. Using his shirt sleeve he wiped away the condensation on one of the door’s panes of glass. He could just make out the figure outside.

“What now?” Hodges muttered as he reached down and unlatched the door. He pulled it wide open and said: “Considering everything it’s a bit strange for you to come visiting, especially at this hour.”

Hodges stared at his visitor, who said nothing. Snow swirled in around Hodges’ legs.

“Oh, hell,” Hodges said with a shrug. “Whatever you want, come in.” He let go of the door and headed toward the kitchen. “Just don’t expect me to play the role of the hospitable host. And close the door behind you!”

When Hodges reached the single step up to the kitchen level, he started to turn to make sure the door had been closed tight against the weather. Out of the corner of his eye he saw something speeding toward his head. By reflex, he ducked.

The sudden movement saved Hodges’ life. A flat metal rod glanced off the side of his head, but not before cutting deeply into his scalp. The force of the blow carried the metal rod to the top of his shoulder where it fractured his collarbone. Its power also sent the stunned Hodges hurtling into the kitchen.

Hodges collided with the kitchen table. His hands clutched the edges, keeping him on his feet. Blood spurted in tiny pulsating jets from the open scalp wound onto his papers. Hodges turned in time to see his attacker closing in on him with arm raised. In a gloved hand he clutched a rod that looked like a short, flat crowbar.

As the weapon started down for a second blow, Hodges reached up and grabbed the exposed forearm, impeding the impact. Still, the metal cut into Hodges’ scalp at the hairline. Fresh blood squirted from severed arteries.

Hodges desperately dug his fingernails into the assailant’s forearm. He knew intuitively he could not let go; he had to keep from being struck again.

For a few moments the two figures struggled against each other. In a dance of death they pirouetted around the kitchen, smashing into the walls, upsetting chairs, and breaking dishes. Blood spattered indiscriminately.

The attacker cried in pain as he pulled his arm free from Hodges’ grip. Once again the steel rod rose up to a frightening apogee before smashing down onto Hodges’ raised forearm. Bones snapped like twigs under the impact.

Again the metal bar was lifted above the now hapless Hodges and brought down hard. This time its arc was unhindered, and the weapon impacted directly onto the top of Hodges’ unprotected head, crushing in a sharply defined fragment of his skull and driving it deeply into his brain.

Hodges fell heavily to the floor, mercifully insensitive.

“We’re coming to a river up ahead,” David Wilson said to his daughter, Nikki, who was sitting in the passenger seat next to him. “Do you know what its name is?”

Nikki turned her mahogany eyes toward her father and pushed a wisp of hair to the side. David hazarded a glance in her direction, and with the help of the sunlight coming through the windshield, he caught some of the subtle spokes of yellow that radiated from her pupils through her irises. They were matched with strands of honey in her hair.

“The only rivers I know,” Nikki said, “are the Mississippi, the Nile, and the Amazon. Since none of them are here in New England, I’ll have to say I don’t know.”

Neither David nor his wife, Angela, could suppress a giggle.

“What’s so funny?” Nikki demanded indignantly.

David looked into the rearview mirror and exchanged knowing glances with Angela. Both were thinking the same thought, and they had spoken of it often: Nikki frequently sounded more mature than expected for her chronological age of eight. They considered the trait an endearing one, indicative of her intelligence. At the same time, they realized their daughter was growing up faster than she might otherwise have because of her health problems.

“Why did you laugh?” Nikki persisted.

“Ask your mother,” David said.

“No, I think your father should explain.”

“Come on, you guys,” Nikki protested. “That’s not fair. But I don’t care if you laugh or not because I can find the name of the river myself.” She took a map from the glove compartment.

“We’re on Highway 89,” David said.

“I know!” Nikki said with annoyance. “I don’t want any help.”

“Excuse me,” David said with a smile.

“Here it is,” Nikki said triumphantly. She twisted the map on its side so she could read the lettering. “It’s the Connecticut River. Just like the state.”

“Right you are,” David said. “And it forms the boundary between what and what?”

Nikki looked back at the map for a moment. “It separates Vermont from New Hampshire.”

“Right again,” David said. And then, gesturing ahead, he added: “And here it is.”

They were all quiet as their blue, eleven-year-old Volvo station wagon sped over the span. Below the water roiled southward.

“I guess the snow is still melting in the mountains,” David said.

“Are we going to see mountains?” Nikki asked.

“We sure are,” David said. “The Green Mountains.”

They reached the other side of the bridge where the highway gradually swung back toward the northwest.

“Are we in Vermont now?” Angela asked,

“Yes, Mom!” Nikki said with impatience.

“How much further to Bartlet?” Angela asked.

“I’m not quite sure,” David said. “Maybe an hour.”

An hour and fifteen minutes later the Wilsons’ Volvo passed the sign reading: “Welcome to Bartlet, Home of Bartlet College.”

David let up on the accelerator and the car slowed. They were on a wide avenue aptly called Main Street. The street was lined with large oaks. Behind the trees were white clapboard homes. The architecture was a potpourri of colonial and Victorian.

“So far it looks story-bookish,” Angela said.

“Some of these New England towns look like they belong in Disney World,” David said.

Angela laughed. “Sometimes I think you feel a replica is better than an original.”

After a short drive the homes gave way to commercial and civic buildings which were constructed mostly of brick with Victorian decorations. In the downtown area stood rows of three- and four-story brick structures. Engraved stone plaques announced the year each was constructed. Most of the dates were either late nineteenth century or early twentieth.

“Look!” Nikki said. “There’s a movie theater.” She pointed at a shabby marquee announcing a current movie in large block letters. Next to the movie theater was a post office with a tattered American flag snapping in the breeze.

“We’re really lucky with this weather,” Angela remarked. The sky was pale blue and dotted with small, puffy white clouds. The temperature was in the high sixties.

“What’s that?” Nikki questioned. “It looks like a trolley with no wheels.”

David laughed. “That’s called a diner,” he said. “They were popular back in the fifties.”

Nikki was straining against her seat belt, excitedly leaning forward to peer out the front windshield.

As they approached the heart of the town they discovered a number of gray granite buildings that were significantly more imposing than the brick structures, especially the Green Mountain National Bank with its corbeled and crenellated clock tower.

“That building really looks like something out of Disney World,” Nikki said.

“Like father, like daughter,” Angela said.

They came to the town green whose grass had already achieved a luxurious, almost midsummer color. Crocuses, hyacinths, and daffodils dotted the park, especially around the gingerbread central gazebo. David pulled the car over to the side of the road and stopped.

“Compared with the section of Boston around Boston City Hospital,” David said, “this looks like heaven.”

At the north end of the park was a large white church whose exterior was rather plain except for its enormous steeple. The steeple was neo-Gothic, replete with elaborate tracery and spires. Its belfry was enclosed by columns supporting pointed arches.

“We’ve got several hours before our interviews. What do you think we should do?” David asked.

“Why don’t we drive around a little more, then have lunch?” Angela said.

“Sounds good to me.” David put the car in gear and continued along Main Street. On the west side of the town green they passed the library which, like the bank, was constructed of gray granite. But it looked more like an Italian villa than a castle.

Just beyond the library was the elementary school. David pulled over to the side of the road so Nikki could see it. It was an appealing turn-of-the-century three-story brick building connected to a nondescript wing of more recent vintage.

“What do you think?” David asked Nikki.

“Would that be where I’d go to school if we come here to live?” Nikki asked.

“Probably,” David said. “I can’t imagine they’d have more than one school in a town of this size.”

“It’s pretty,” Nikki said noncommittally.

Driving on, they quickly passed through the commercial section. Then they found themselves in the middle of the Bartlet College campus. The buildings were mostly the same gray granite they’d seen in the town and had the same white trim. Many were covered with ivy.

“A lot different from Brown University,” Angela said. “But charming.”

“I often wonder what it would have been like if I’d gone to a small college like this,” David said.

“You wouldn’t have met Mommy,” Nikki said. “And then I wouldn’t be here.”

David laughed. “You’re so right and I’m so happy I went to Brown.”

Looping through the college, they headed back toward the center of town. They crossed over the Roaring River and discovered two old mill buildings. David explained to Nikki how water power was used in the old days. One of the mills now housed a computer software company, but its water wheel was slowly turning. A sign advertised that the other mill was now the New England Goat Hanger Company.

Back in town David parked at the town green. This time they got out and strolled up Main Street.

“It’s amazing, isn’t it: no litter, no graffiti, and no homeless people,” Angela said. “It’s like a different country.”

“What do you think of the people?” David asked. They had been passing pedestrians since they’d gotten out of the car.

“I’d say they look reserved,” Angela said. “But not unfriendly.”

David stopped outside of Staley’s Hardware Store. “I’m going to run in and ask where we should eat.”

Angela nodded. She and Nikki were looking into the window of the neighboring shoe store.

David was back in a flash. “The word is that the diner is best for a quick lunch, but the Iron Horse Inn has the best food. I vote for the diner.”

“Me too,” Nikki said.

“Well, that settles that,” Angela said.

All three had hamburgers the old-fashioned way: with toasted buns, raw onion, and lots of ketchup. When they were through, Angela excused herself.

“There’s no way I’m going to an interview until I brush my teeth,” she said.

David took a handful of mints after paying the check.

On the way back to the car they approached a woman coming in their direction with a golden retriever puppy on a leash.

“Oh, how cute!” Nikki exclaimed.

The woman graciously stopped so Nikki could pet the dog.

“How old is she?” Angela asked.

“Twelve weeks,” the woman said.

“Could you direct us to the Bartlet Community Hospital?” David asked.

“Certainly,” the woman said. “Go up to the town green. The road on the right is Front Street. Take that right up to the hospital’s front door.”

They thanked the woman and moved on. Nikki walked sideways to keep the puppy in sight. “He was darling,” she said. “If we come to live here, may I have a dog?”

David and Angela exchanged glances. Both were touched. Nikki’s modest request after all the medical problems she’d been through melted their hearts.

“Of course you may have a dog,” Angela said.

“You can even pick it out,” David said.

“Well, then I want to come here,” Nikki said with conviction. “Can we?”

Angela looked at David in hopes he would answer, but he gestured for her to field the question. Angela wrestled with her answer. She didn’t know what to say. “Whether we come here or not is a difficult decision,” she said finally. “There are many things we have to consider.”

“Like what?” Nikki asked.

“Like whether they want me and your father,” Angela said, relieved to have come up with a simple explanation, as the three got back in their car.

Bartlet Community Hospital was larger and more imposing than David or Angela had expected, even though they knew it was a referral center for a significant portion of the state.

Despite a sign that clearly said “Parking in the Rear,” David pulled to the curb in the turnout before the front entrance. He put the car in park but left the engine running.

“This is truly beautiful,” he said. “I never thought I would say that about a hospital.”

“What a view,” Angela said.

The hospital was midway up a hill just north of the town. It faced south and its facade was bathed in bright sunlight. Just below them at the base of the hill they could see the whole town. The Methodist church’s steeple was especially prominent. In the distance the Green Mountains provided a scalloped border to the horizon.

Angela tapped David’s arm. “We’d better get inside,” she said. “My interview is in ten minutes.”

David put the car in gear and drove around to the back of the hospital. There were two parking lots rising up in terraced tiers separated by a stand of trees. They found visitor slots next to the hospital’s rear entrance in the lower lot.

Appropriately placed signs made finding the administrative offices easy, and a helpful secretary directed them to Michael Caldwell’s office. Michael Caldwell was Bartlet’s medical director.

Angela knocked on the jamb of the open door. Inside, Michael Caldwell looked up from his desk, then rose to greet her. He immediately reminded Angela of David with his olive coloring and trim, athletic build. He was also close to David’s age of thirty, as well as his height of six feet. Like David’s, his hair tended to form a natural center part. But there the similarities ended. Caldwell’s features were harder than David’s; his nose was hawk-like and narrower.

“Come in!” Caldwell said with enthusiasm. “Please! All of you.” He quickly got more chairs.

David looked at Angela for guidance. Angela shrugged. If Caldwell wanted to interview the whole family, it was fine with her.

After brief introductions, Caldwell was back behind his desk with Angela’s folder in front of him. “I’ve been over your application, and I have to tell you I am indeed impressed,” he said.

“Thank you,” Angela said.

“Frankly, I didn’t expect a woman pathologist,” Caldwell said. “Subsequently I’ve learned it’s a field that is appealing to more and more women.”

“The hours tend to be more predictable,” Angela said. “It makes the practice of medicine and having a family more compatible.” She studied the man. His comment made her slightly uncomfortable, but she was willing to withhold judgment.

“From your letters of recommendation I have the feeling that the department of pathology at the Boston City Hospital thinks you have been one of their brightest residents.”

Angela smiled. “I’ve tried to do my best.”

“And your transcript from Columbia’s medical school is equally impressive,” Caldwell said. “Consequently, we would like to have you here at Bartlet Community Hospital. It’s as simple as that. But perhaps you have some questions for me.”

“David has also applied for a job in Bartlet,” Angela said. “It’s with one of the major health maintenance organizations in the area: Comprehensive Medical Vermont.”

“We call it CMV,” Caldwell said. “And it’s the only HMO in the area.”

“I indicated in my letter that my availability is contingent on his acceptance,” Angela said. “And vice versa.”

“I’m well aware of that,” Caldwell said. “In fact I took the liberty of contacting CMV and talking about David’s application with the regional manager, Charles Kelley. CMV’s regional office is right here in our professional building. Of course I cannot speak for them officially, but it is my understanding there is no problem whatsoever.”

“I’m to meet with Mr. Kelley as soon as we’re through here,” David said.

“Perfect,” Caldwell said. “So, Dr. Wilson, the hospital would like to offer you a position as associate pathologist. You’ll join two other full-time pathologists. Your first year’s compensation will be eighty-two thousand dollars.”

When Caldwell looked down at the folder on his desk, Angela looked David’s way. Eighty-two thousand dollars sounded like a fortune after so many years of burdensome debt and meager income. David flashed her a conspiratorial smile in return, obviously sharing her thoughts.

“I also have some information in response to your query letter,” Caldwell said. He hesitated, then added: “Perhaps this is something we should talk about privately.”

“It’s not necessary,” Angela said. “I assume you are referring to Nikki’s cystic fibrosis. She’s an active participant in her care, so there are no secrets.”

“Very well,” Caldwell said. He smiled meekly at Nikki before continuing. “I found out that there is a patient with that condition here in Bartlet. Her name is Caroline Helmsford. She’s nine years old. I’ve arranged for you to meet with her doctor, Dr. Bertrand Pilsner. He’s one of CMV’s pediatricians.”

“Thank you for making such an effort,” Angela said.

“No problem,” Caldwell said. “Obviously we want you folks to come here to our delightful town. But I must confess that I didn’t read up on the condition when I made the inquiries. Perhaps there is something I should know in order to be of more assistance.”

Angela looked at Nikki. “Why don’t you explain to Mr. Caldwell what cystic fibrosis is.”

“Cystic fibrosis is an inherited problem,” Nikki said in a serious and practiced tone. “When both parents are carriers there is a twenty-five percent chance a child will have the condition. About one in every two thousand babies is affected.”

Caldwell nodded and tried to maintain his smile. There was something unnerving about getting a lecture from an eight-year-old.

“The main problem is with the respiratory system,” Nikki continued. “The mucus in the lungs is thicker than in the lungs of normal people. The lungs have difficulty clearing the thicker mucus which leads to congestion and infection. Chronic bronchitis and pneumonia are the big worries. The condition is quite variable: some people are severely affected; others, like me, just have to be careful not to catch colds and do our respiratory therapy.”

“Very interesting,” Caldwell said. “You certainly sound professional. Maybe you should be a doctor when you grow up.”

“I intend to,” Nikki said. “I’m going to study respiratory medicine.”

Caldwell got up and gestured toward the door. “How about you doctors and doctor-to-be going over to the medical office building to meet Dr. Pilsner.”

It was only a short walk from the hospital’s administrative area in the old central building to the newer professional building. In just a few minutes they passed through a fire door, and the corridor covering changed from vinyl tile to posh carpet.

Dr. Pilsner was in the middle of his afternoon office hours but graciously took time to meet the Wilsons. His thick white beard made him look a bit like Kris Kringle. Nikki took to him immediately when he bent down and shook her hand, treating her more like an adult than a child.

“We’ve got a great respiratory therapist here at the hospital,” Dr. Pilsner said to the Wilsons. “And the hospital is well equipped for respiratory care. On top of that I took a fellowship in respiratory medicine at Children’s in Boston. So I think we can take care of Nikki just fine.”

“Wow!” Angela said, obviously impressed, and relieved. “This is certainly comforting. Ever since Nikki’s diagnosis we take her special needs into consideration in all our decision-making.”

“And indeed you should,” Dr. Pilsner said. “Bartlet would be a good choice with its low pollution and clean, crisp air. Provided she has no tree or grass allergies, I think it would be a healthy environment for your daughter.”

Caldwell escorted the Wilsons to CMV’s regional headquarters. Before he left he made them promise to return to his office after David’s interview.

The CMV receptionist directed the Wilsons to a small waiting area. The three of them barely had time to pick up magazines before Charles Kelley emerged from his private office.

Kelley was a big man who towered eight inches over David as they shook hands. His face was tanned and his sandy-colored hair had pure blond streaks running through it. He was dressed in a meticulously tailored suit. His manner was outgoing and ebullient, more like a high-powered super-salesman than a health care administrator.

Like Caldwell, Kelley invited the whole Wilson family into his office. He was also equally complimentary.

“Frankly, we want you, David,” Kelley said, tapping a closed fist on his desk. “We need you as part of our team. We’re pleased that you’ve taken an internal medicine residency, especially at a place like the Boston City Hospital. As more of the city moves to the country, we’re finding we need your kind of expertise. You’ll be an enormous addition to our primary care/gatekeeper crew, no doubt about it.”

“I’m pleased you’re pleased,” David said with an embarrassed shrug.

“CMV is expanding rapidly in this area of Vermont, especially in Bartlet itself,” Kelley boasted. “We’ve signed up the coat-hanger mill, the college, and the computer software company, as well as all the state and municipal employees.”

“Sounds like a monopoly,” David joked.

“We’d rather think it has to do with our dedication to quality care and cost control,” Kelley said.

“Of course,” David agreed.

“Your compensation will be forty-one thousand the first year,” Kelley said.

David nodded. He knew he’d be in for some teasing from Angela even though they’d known all along that her earnings would be significantly larger than his. On the other hand, they hadn’t expected hers would be double his.

“Why don’t I show you your prospective office,” Kelley said eagerly. “It will give you a better feeling for our operation and what it will be like working here.”

David looked at Angela. Kelley’s approach was certainly a harder sell than was Caldwell’s.

To David’s mind the office was dream-like. The view south over the Green Mountains was so picture-perfect, it looked like a painting.

David noticed four patients sitting in the waiting area reading magazines. He looked to Kelley for an explanation.

“You’ll be sharing this suite with Dr. Randall Portland,” Kelley explained. “He’s an orthopedic surgeon. A good guy, I might add. We’ve found that sharing receptionists and nurses is an efficient use of resources. Let me see if he’s available to say hello.”

Kelley walked over and tapped on what David thought was merely a mirror. It slid open. Behind it was a receptionist. Kelley spoke to her for a moment before the mirrored partition slid closed.

“He’ll be out in a second,” Kelley said, rejoining the Wilsons. He then explained the layout of the office. Opening a door on the west side of the waiting room, he gave them a tour of empty, newly redecorated examining rooms. He also took them into the room that would be David’s private office It had the same fabulous view to the south as the waiting room.

“Hello everybody,” a voice called out. The Wilsons turned from gaping out the window to see a youthful but strained-appearing man stride into the room. It was Dr. Randall Portland. Kelley introduced them all, even Nikki, who shook hands like she’d done with Dr. Pilsner.

“Call me Randy,” Dr. Portland said as he shook David’s hand.

David sensed the man was sizing him up.

“You play basketball?” Randy asked.

“Occasionally,” David said. “Lately I haven’t had much time.”

“I hope you come to Bartlet,” Randy said. “We need some more players around here. At least someone to take my place.”

David smiled.

“Well, it’s nice to meet you folks. I’m afraid I have to get back to work.”

“He’s a busy man,” Kelley explained after Dr. Portland left. “We currently only have two orthopedists. We need three.”

David turned back to the mesmerizing view.

“Well, what do you say?” Kelley questioned.

“I’d say we’re pretty impressed,” David said. He looked at Angela.

“We’ll have to give it all a lot of thought,” Angela said.

After leaving Charles Kelley, the Wilsons returned to Caldwell’s office. He insisted on taking David and Angela on a quick tour of the hospital. Nikki was left in the hospital day-care center, run by pink-frocked volunteers.

The first stop on the tour was the laboratory. Angela was not surprised to find that the lab was truly state-of-the-art. After he showed her the pathology section where she’d be doing most of her work, Caldwell took her in to meet the department chairman, Dr. Benjamin Wadley.

Dr. Wadley was a distinguished-looking, silver-haired gentleman in his fifties. Angela was immediately struck by how much he reminded her of her father.

After the introductions, Dr. Wadley said he understood that David and Angela had a little girl. Before they could respond, he raved about the local school system. “My kids really thrived. One is now at Wesleyan in Connecticut. The other is a senior in high school and has already gotten early acceptance into Smith College.”

A few minutes later, after bidding Dr. Wadley goodbye, Angela pulled David aside as they followed Caldwell.

“Did you notice the similarity between Dr. Wadley and my father?” Angela whispered.

“Now that you say it, yes,” David said. “He has that same kind of poise and confidence.”

“I thought it was rather remarkable,” Angela said.

“Let’s not have any hysterical transference,” David joked.

Next on the tour was the ER, followed by the Imaging Center. David was particularly impressed with the newly acquired MRI machine.

“This is a better machine than the one at Boston City Hospital,” David remarked. “Where did the money come from for this?”

“The Imaging Center is a joint venture between the hospital and Dr. Cantor, one of the staff doctors,” Caldwell explained. “They upgrade the equipment all the time.”

After the Imaging Center, David and Angela toured the new radiotherapy building which boasted one of the newest linear accelerators. From there they returned to the main hospital and the new neonatal critical care unit.

“I don’t know what to say,” David admitted when the tour was over.

“We’d heard the hospital was well equipped,” Angela said, “but this is far better than we’d imagined.”

“We’re understandably proud of it,” Caldwell said as he led them back into his office. “We had to significantly upgrade in order to land the CMV contract. We had to compete with the Valley Hospital and the Mary Sackler Hospital for survival. Luckily, we won.”

“But all this equipment and upgrading had to cost a fortune,” David said.

“That’s an understatement,” Caldwell agreed. “It’s not easy these days running a hospital, especially in this era of government-mandated competition. Revenues are down, costs are going up. It’s hard just to stay in business.” Caldwell handed David a manila envelope. “Here’s a packet of information about the hospital. Maybe it will help convince you to come up here and accept our job offers.”

“What about housing?” Angela asked as an afterthought.

“I’m glad you asked,” Caldwell said. “I was supposed to ask you to go down to the Green Mountain National Bank to see Barton Sherwood. Mr. Sherwood is the vice chairman of the hospital board. He’s also president of the bank. He’ll give you an idea how much the town supports the hospital.”

After rescuing a reluctant Nikki from the day-care center where she’d been enjoying herself, the Wilsons drove back to the town green and walked to the bank. Typical of their reception in Bartlet, Barton Sherwood saw them immediately.

“Your applications were favorably discussed at the last executive board meeting,” Barton Sherwood told them as he leaned back in his chair and hooked his thumbs in his vest pockets. He was a slight man, nearing sixty, with thinning hair and a pencil-line mustache. “We sincerely hope you’ll be joining the Bartlet family. To encourage you to come to Bartlet, I want you to know that Green Mountain National Bank is prepared to offer both first and second mortgages so that you’ll be able to buy a house.”

David and Angela were stunned and their jaws dropped in unison. Never in their wildest imaginations had they thought they would have been able to buy a house the first year out of their residencies. They had very little cash, and a mountain of tuition debt: over a hundred and fifty thousand dollars.

Sherwood went on to give them the specifics, but neither David nor Angela could focus on the details. It wasn’t until they were back in their car that they dared to speak.

“I can’t believe this,” David said.

“It’s almost too good to be true,” Angela agreed.

“Does this mean we’re coming to Bartlet?” Nikki asked.

“We’ll see,” Angela said.

Since David had driven up from Boston, Angela offered to drive home. As she drove, David perused the information packet Caldwell had given them.

“This is interesting,” David said. “There’s a clip from the local paper about the signing of the contract between Bartlet Community Hospital and CMV. It says that the deal was consummated when the hospital board, under the leadership of Harold Traynor, finally agreed to CMV’s demand to provide hospitalization for an unspecified monthly capitation fee, a method of cost control encouraged by the government and favored by HMO organizations.”

“That’s a good example of how providers like hospitals and doctors are being forced to make concessions,” Angela said.

“Right you are,” David agreed. “By accepting capitation the hospital has been forced to act like an insurance organization. They are assuming some of the health risk of the CMV subscribers.”

“What’s capitation?” Nikki asked.

David swung around. “Capitation is when an organization is paid a certain amount of money per person,” he explained. “With health plans it’s usually by the month.”

Nikki still looked puzzled.

David tried again. “Let’s be specific. Say that CMV pays Bartlet Hospital a thousand dollars each month for each person in the plan. Then if anybody has to be hospitalized during the month for whatever reason, CMV doesn’t have to pay any more. So if no one gets sick for the month, the hospital makes out like a bandit. But what if everybody gets sick and has to go to the hospital? What do you think will happen then?”

“I think you still might be over her head,” Angela said.

“I understand,” Nikki said. “If everybody got sick the hospital would go broke.”

David smiled with satisfaction and gave Angela a playful poke in the ribs. “Hear that?” he said triumphantly. “That’s my daughter.”

A few hours later, they were back home near their Southend apartment. Angela was lucky enough to find a spot only half a block from their door. David gently woke Nikki, who’d drifted off to sleep. Together the three walked to their building and mounted the stairs to their fourth-floor walk-up.

“Uh oh!” Angela said. She was the first to reach their apartment.

“What’s the matter?” David asked. He looked over her shoulder.

Angela pointed at the door. The trim was split from the point where a crowbar had been inserted. David reached out and pushed the door. It opened with no resistance. All three locks had been broken.

David reached in and turned on the light. The apartment had been ransacked: furniture upended and the contents of cabinets and drawers scattered about the floor.

“Oh, no!” Angela cried as tears welled in her eyes.

“Easy!” David said. “What’s been done is done. Let’s not get hysterical.”

“What do you mean, ‘Let’s not get hysterical’?” Angela demanded. “Our home’s been ruined. The TV’s gone.”

“We can get another TV,” David said calmly.

Nikki came back from her room and reported that it hadn’t been touched.

“At least we can be thankful for that,” David said.

Angela disappeared into their bedroom while David surveyed the kitchen. Except for a partially empty container of ice cream melted on the counter, the kitchen was fine.

David picked up the phone and dialed 911. While he was waiting for the call to go through, Angela appeared with tears streaming down her face, holding a small, empty jewelry box.

After David gave the details to the 911 operator, he turned to Angela. She was struggling to maintain control.

“Just don’t say anything super-rational,” Angela managed through her tears. “Don’t say we can get more jewelry.”

“Okay, okay,” David said agreeably.

Angela dried her face on her sleeve. “Coming home to this rape of our apartment makes Bartlet seem that much more appealing,” she said. “At this point I’m more than ready to leave urban ills behind.”

“I don’t have anything against him personally,” Dr. Randall Portland told his wife, Arlene, as they got up from the dinner table. She motioned their two sons, Mark and Alien, to help clear the table. “I just don’t want to share my office with an internist.”

“Why not?” Arlene asked, taking the dishes from her sons and scraping food scraps into the disposal.

“Because I don’t want my post-ops sharing a waiting room with a bunch of sick people,” Randy snapped. He recorked the unfinished bottle of white wine and put it into the refrigerator.

“Okay,” Arlene said. “That I can understand. I was afraid it was some juvenile surgeon-internist squabble.”

“Don’t be ridiculous,” Randy said.

“Well, you remember all the jokes you used to have about internists when you were a resident,” Arlene reminded him.

“That was healthy verbal sparring,” Randy said. “But this is different. I don’t want infectious people around my patients. Call it superstitious, I don’t care. But I’ve been having more than my share of complications with my patients and it has me depressed.”

“Can we watch TV?” Mark asked. Alien, with his angelically huge eyes, was standing behind him. They were seven and six years old respectively.

“We already agreed that  .  .  .” Arlene began, but then she stopped. It was hard to resist her sons’ pleading expressions. Besides, she wanted a moment alone with Randy. “Okay, a half hour.”

“Yippie!” Mark exclaimed. Alien echoed him before they dashed off to the family room.

Arlene took Randy by the arm and led him into the living room. She had him sit on the couch, and she took the chair opposite. “I don’t like the way you are sounding,” she said. “Are you still upset about Sam Flemming?”

“Of course I’m still upset about Sam Flemming,” Randy said irritably. “I didn’t lose a patient all through my residency. Now I’ve lost three.”

“There are some things you cannot control,” Arlene said.

“None of them should have died,” Randy said. “Especially under my care. I’m just a bone doctor screwing around with their extremities.”

“I thought you were over your depression,” Arlene said.

“I’m having trouble sleeping again,” Randy admitted.

“Maybe you should call Dr. Fletcher,” Arlene suggested.

Before Randy could respond the phone rang. Arlene jumped. She’d been learning to hate its sound, especially when Randy had post-ops in the hospital. She answered on the second ring, hoping that it was a social call. Unfortunately it wasn’t. It was one of the floor nurses at Bartlet Community Hospital wanting to speak with Dr. Portland.

Arlene handed the phone to her husband. He took it reluctantly and put it to his ear. After he’d listened for a moment, his face blanched. He replaced the receiver slowly and raised his eyes to Arlene’s.

“It’s the knee I did this morning,” Randy said. “William Shapiro. He’s not doing well. I can’t believe it. It sounds the same. He’s spiked a fever and he’s disoriented. Probably pneumonia.”

Arlene stepped up to her husband and put her arms around him and gave him a squeeze. “I’m sorry,” she said, not knowing what else to say.

Randy didn’t respond. Nor did he try to move for a few minutes. When he did, he silently disengaged Arlene’s arms, and went out the back door without speaking. Arlene watched from the kitchen window as his car descended the driveway and pulled out into the street. She straightened up and shook her head. She was worried about her husband, but she didn’t know what to do.

Harold Traynor fingered the mahogany and inlaid gold gavel he’d bought for himself at Shreve Crump & Low in Boston. He was standing at the head of the library table in the Bartlet Community Hospital. In front of him was the lectern that he had had built for the hospital conference room. Scattered on its surface were his extensive notes which he’d had his secretary type up early that morning. Stretching out from the lectern and scattered down the center of the table was the usual collection of medical paraphernalia in various stages of evaluation by the hospital board. Dominating the confusion was the model of the proposed parking garage.

Traynor checked his watch. It was exactly six p.m. Taking the gavel in his right hand, he struck it sharply against its base. Attentiveness to detail and punctuality were two characteristics Traynor particularly prized.

“I would like herewith to call to order the Executive Committee of the Bartlet Community Hospital,” Traynor called out with as much pompousness as he could muster. He was dressed in his best pin-striped suit. On his feet were freshly polished elevator shoes. He was only five foot seven and felt cheated as far as stature was concerned. His dark, receding hair was neatly trimmed and carefully combed over his apical bald spot.

Traynor spent a great deal of time and effort preparing for hospital board meetings, both in terms of content and his appearance. That day he’d gone directly home to shower and change clothes after a day trip to Montpelier. With no time to spare, he did not stop at his office. Harold Traynor was an attorney in Bartlet specializing in estate planning and tax work. He was also a businessman with interests in a number of commercial ventures in the town.

Seated before him were Barton Sherwood, vice chairman; Helen Beaton, president and CEO of the hospital; Michael Caldwell, vice president and medical director of the hospital; Richard Arnsworth, treasurer; Clyde Robeson, secretary; and Dr. Delbert Cantor, current chief of staff.

Strictly following parliamentary procedure as specified in Robert’s Rules of Order, which he’d purchased after being elected to the chairmanship, Traynor called on Clyde Robeson to read the minutes of the last meeting.

As soon as the minutes had been read and approved, Traynor cleared his throat in preparation for his monthly chairman’s report. He looked at each member of his executive committee in turn, making sure they were all attentive. They were, except for Dr. Cantor who was, typically, bored and busily cleaning under his fingernails.

“We face significant challenges here at the Bartlet Community Hospital,” Traynor began. “As a referral center we have been spared some of the financial problems of smaller rural hospitals, but not all of them. We’re going to have to work even harder than we have in the past if the hospital is to survive these difficult days.

“However, even in these dark times there is occasional light. As some of you have undoubtedly heard, an esteemed client of mine, William Shapiro, passed away last week of pneumonia coming on after knee surgery. While I very much regret Mr. Shapiro’s untimely passing, I am pleased to announce officially that Mr. Shapiro had generously designated the hospital as the sole beneficiary of a three-million-dollar insurance policy.”

A murmur of approval spread through the people present.

Traynor lifted his hand for silence. “This charitable gesture couldn’t have come at a better time. It will pull us out of the red and push us into the black, although not for long. The bad news for the month is the recent discovery that our sinking fund for our major bond issues is considerably short of its projected goals.”

Traynor looked directly at Sherwood, whose mustache twitched nervously.

“The fund will need to be bolstered,” Traynor said. “A good portion of the three-million-dollar bequest will have to go to that end.”

“It wasn’t all my fault,” Sherwood blurted out. “I was urged to maximize return on the fund. That necessitated risk.”

“The chair does not recognize Barton Sherwood,” Traynor snapped.

For a moment, Sherwood looked as if he might respond, but instead he remained silent.

Traynor studied his notes in an effort to compose himself after Sherwood’s outburst. Traynor hated disorder.

“Thanks to Mr. Shapiro’s bequest,” Traynor went on, “the sinking fund debacle will not be lethal. The problem is to keep any outside examiners from getting wind of the shortfall. We can’t afford to have our bond rating change. Consequently, we will be forced to put off floating a bond issue for the parking garage until the sinking fund is restored.

“As a temporary measure to forestall assaults on our nurses I have instructed our CEO, Helen Beaton, to have lighting installed in the parking lot.”

Traynor glanced around the room. According to the Rules of Order, the matter should have been presented as a motion, debated, and voted on, but no one moved to be recognized.

“The last item concerns Dr. Dennis Hodges,” Traynor said. “As you all know, Dr. Hodges disappeared last March. During this past week I met with our chief of police, Wayne Robertson, to discuss the case. No clues as to his whereabouts have surfaced. If Dr. Hodges did meet with foul play, there has been no evidence of it, although Chief Robertson allowed that the longer Dr. Hodges is missing, the more likely it is that he is no longer living.”

“My guess is he’s still around,” Dr. Cantor said. “Knowing that bastard, he’s probably sitting down in Florida, laughing himself silly every time he thinks of us wrestling with all this bureaucratic bullshit.”

Traynor used his gavel. “Please!” he called out. “Let’s maintain some order here.”

Cantor’s bored expression changed to disdain, but he remained silent.

Traynor glared at Dr. Cantor before resuming: “Whatever personal feelings we may have about Dr. Hodges, the fact remains that he played a crucial role in the history of this hospital. If it hadn’t been for him this institution would be merely another tiny, rural hospital. His welfare merits our concern.

“I wanted the executive committee to know that Dr. Hodges’ estranged wife, Mrs. Hodges, has decided to sell her home. She relocated to her native Boston some years ago. She had held out some hope that her husband might resurface, but based on her conversations with Chief Robertson, she has decided to sever her connections with Bartlet. I only raise this matter now because I think that sometime in the near future the board might wish to erect a memorial befitting Dr. Hodges’ considerable contributions to Bartlet Community Hospital.”

Having finished, Traynor gathered up his notes and formally turned the meeting over to Helen Beaton so that she could give her monthly president’s report. Beaton stood up in her place, pushing her chair back from the table. She was in her mid-thirties with reddish-brown hair cut short. Her face was wide, not unlike Traynor’s. She wore a businesslike blue suit accented with a silk scarf.

“I’ve spoken to several civic groups this month,” she said. “My topic on each occasion was the financial plight of the hospital. It was interesting for me to ascertain that most people were generally unaware of our problems even though health-care issues have been almost constantly in the news. What I emphasized in my talks was the economic importance of the hospital to the town and the immediate area. I made it very clear that if the hospital were to close, every business and every merchant would be hurt. After all, the hospital is the largest employer in this part of the state. I also reminded everyone that there is no tax base for the hospital and that fundraising has been and will remain key to keeping the doors open.”

Beaton paused as she turned over the first page of her notes. “Now for the bad news,” she said, referring to several large graphs illustrating the information she was about to relay. She held the graphs at chest height as she spoke. “Admissions for April were twelve percent over forecast. Our daily census was up eight percent over March, and our average length of stay was up six percent. Obviously these are serious trends as I’m sure our treasurer, Richard Arnsworth, will report.”

Beaton held up the last graph. “And finally I have to report that there has been a drop in utilization of the emergency room which, as you know, is not part of our capitation agreement with CMV. And to make matters worse, CMV has refused to pay a number of our ER claims, saying the subscribers violated CMV rules.”

“Hell, that’s not the hospital’s fault,” Dr. Cantor said.

“CMV doesn’t care about such technicalities,” Beaton said. “Consequently, we’ve been forced to bill the patients directly and they are understandably upset. Most have refused to pay, telling us to go to CMV.”

“Health care is becoming a nightmare,” Sherwood said.

“Tell that to your representative in Washington,” Beaton said.

“Let’s not digress,” Traynor said.

Beaton looked back at her notes, then continued: “Quality indicators for April were within normal expectations. Incident reports were actually fewer than in March and no new malpractice actions have been initiated.”

“Will wonders never cease,” Dr. Cantor commented.

“Other disturbing news for April involved union agitation,” Beaton continued. “It was reported to us that both dietary and housekeeping have been targeted. Needless to say, unionization would significantly add to our financial problems.”

“It’s one crisis after another,” Sherwood said.

“Two areas of under-utilization,” Beaton continued, “are the neonatal intensive care unit and the linear accelerator. During April, I discussed this situation with CMV since our fixed costs for maintaining these units are so high. I emphasized it had been they who demanded these services. CMV promised me that they would look into ferrying patients from areas without these facilities to Bartlet and reimbursing us accordingly.”

“That reminds me,” Traynor said. As chairman, he felt he had the right to interrupt. “What is the status of the old cobalt-60 machine that the linear accelerator replaced? Have there been any inquiries from the state licensing division or the nuclear regulatory commission?”

“Not a word,” Beaton answered. “We informed them the machine is in the process of being sold to a government hospital in Paraguay and that we are waiting for the funds.”

“I don’t want to get involved in any bureaucratic snafu with that machine,” Traynor warned.

Beaton nodded and turned to the last page of her notes. “And finally, I’m afraid I have some additional bad news. Last night just before midnight there was another attempted assault in the parking lot.”

“What?” Traynor cried. “Why wasn’t I informed about this?”

“I didn’t hear about it until this morning,” Beaton explained. “I tried to call you as soon as I heard, but you weren’t in. I left a message for you to call back but you never did.”

“I was in Montpelier all day,” Traynor explained. He shook his head in dismay. “Damn, this has to stop. It’s a PR nightmare. I hate to imagine what CMV thinks.”

“We need that garage,” Beaton said.

“The garage has to wait until we can float a bond issue,” Traynor said. “I want that lighting done quickly, understand?”

“I’ve already talked to Werner Van Slyke,” Beaton said. “And he’s already gotten back to me that he’s been in touch with the electrical contractor. I’ll follow up on it so that it’s done ASAP.”

Traynor sat down heavily and blew through pursed lips. “It’s almost mind-boggling what running a hospital today entails. Why did I get myself into this?” He picked up the current meeting’s agenda, glanced at it, then called Richard Arnsworth, the treasurer, to give his report.

Arnsworth got to his feet. He was a bespectacled, precise, accountant type whose voice was so soft everyone had to strain to hear him. He started by referring everyone to the balance sheet each had received in his information packet that morning.

“What’s immediately obvious,” Arnsworth said, “is that the monthly expenses still significantly outstrip the monthly capitation payments from CMV. In fact, the gap has expanded relative to the increase in admissions and lengths of stay. We’re also losing money on all Medicare patients not enrolled in CMV as well as all indigents who are not enrolled in any plan. The percentage of paying patients or those with standard indemnity insurance is so tiny we cannot cost-shift enough to cover our losses.

“As a result of this continued loss, the hospital’s cash position has deteriorated. Consequently, I recommend switching from one hundred and eighty days investing to thirty days.”

“It’s already been taken care of,” Sherwood announced.

When Arnsworth took his seat, Traynor asked for a motion to approve the treasurer’s report. It was immediately seconded and carried with no opposition. Traynor then turned to Dr. Cantor to give the medical staff report.

Dr. Cantor got to his feet slowly and leaned his knuckles on the table. He was a big, heavyset man with a pasty complexion. Unlike other presenters he didn’t refer to notes.

“Just a couple of things this month,” he said casually. Traynor glanced over at Beaton and caught her eye, then shook his head in disgust. He hated Cantor’s jaded behavior at their meetings.

“The anesthesiologists are all up in arms,” Dr. Cantor said. “But of course it’s expected now that they have been officially informed that the hospital is taking over the department, and they’re to be on straight salary. I know how they feel since I experienced the same situation during Hodges’ tenure.”

“Do you think they’ll sue?” Beaton asked.

“Of course they’ll sue,” Dr. Cantor said.

“Let them,” Traynor said. “The precedent’s been well established with pathology and radiology. I cannot believe they’d think they could continue with private billing while we’re under capitation. It doesn’t make sense.”

“A new utilization manager has been chosen,” Dr. Cantor said, changing the subject. “His name is Dr. Peter Chou.”

“Will Dr. Chou cause any problems for us?” Traynor asked.

“I doubt it,” Dr. Cantor said. “He didn’t even want the position.”

“I’ll meet with him,” Beaton said.

Traynor nodded.

“And the last item concerning the medical staff,” Dr. Cantor said, “involves M.D. 91. I’ve been told he’s not been drunk all month.”

“Leave him on probation just the same,” Traynor said. “Let’s not take any chances. He’s relapsed before.”

Dr. Cantor sat down.

Traynor asked if there was any new business. When no one moved, he asked for a motion to adjourn. Dr. Cantor eagerly “so moved.” After a resounding chorus of “yeas,” Traynor struck the gavel and ended the meeting.

Traynor and Beaton slowly gathered up their papers. Everyone else trooped out of the conference room, heading for the Iron Horse Inn. When the sound of the outer door closing behind the departing group drifted back to the room, Traynor’s eyes met Beaton’s. Leaving his briefcase, Traynor stepped around the table and passionately embraced her.

Hand in hand they hurriedly left the conference room and retreated across the hall to a couch in Beaton’s office as they had so many times before. There in the semi-darkness they made frenzied love just as they had after each executive committee meeting for almost a year. It was a familiar scenario and didn’t take long. They didn’t bother to remove their clothes.

“I thought it was a good meeting,” Traynor said as they rearranged their apparel after they were through.

“I agree,” Beaton said. She turned on a light and went over to a wall mirror. “I liked the way you handled the lighting issue for the parking lot. It avoided needless debate.”

“Thank you,” Traynor said, pleased with himself.

“But I’m worried about the financial situation,” Beaton admitted as she reapplied her makeup. “The hospital has to break even at the very least.”

“You’re right,” Traynor admitted with a sigh. “I’m worried too. I’d love to wring some of those CMV people’s necks. It’s ironic that this ‘managed competition’ nonsense could very well force us into bankruptcy. That whole year of negotiations with CMV was a lose-lose situation. If we hadn’t agreed to capitate, we wouldn’t have gotten the contract and we would have had to close like the Valley Hospital. Now that we did agree to capitate, we still might have to close.”

“Every hospital is having trouble,” Beaton said. “We should keep that in mind, although it’s hardly consolation.”

“Do you think there is any chance we could renegotiate the contract with CMV?” Traynor asked.

Beaton laughed scornfully. “Not a chance,” she said.

“I don’t know what else to do,” Traynor said. “We’re losing money despite our DUM plan that Dr. Cantor proposed.”

Beaton laughed with true mirth. “We have to alter that acronym. It sounds ridiculous. How about changing from Drastic Utilization Measures to Drastic Utilization Control. DUC sounds a lot better than DUM.”

“I kind of like DUM,” Traynor said. “It reminds me that it was dumb to set our capitation rate so low.”

“Caldwell and I have come up with an idea that might help significantly,” she said. She pulled a chair over and sat down in front of Traynor.

“Shouldn’t we be getting down to the Iron Horse?” Traynor said. “We don’t want anybody getting suspicious. This is a small town.”

“This will only take a moment,” Beaton promised. “What Caldwell and I did was brainstorm about how the consultants we hired came up with a capitation rate that has proved to be too low. What we realized was that we’d provided them with hospitalization statistics that CMV had given us. What no one remembered was that those statistics were based on experience CMV had with its own hospital in Rutland.”

“You think CMV gave us fraudulent numbers?” Traynor asked.

“No,” Beaton said. “But like all HMOs when they are dealing with their own hospitals, CMV has an economic incentive for their doctors to limit hospitalization, something the public has no idea about.”

“You mean like actual payments to the doctors?” Traynor asked.

“Exactly,” Beaton said. “It’s a bonus bribe. The more each doctor cuts his hospitalization rates the bigger the bonus. It’s very effective. Caldwell and I believe we can fashion a similar economic incentive here at Bartlet Community Hospital. The only problem is that we will have to fund it with some start-up capital. Once it’s operational, it will pay for itself by reducing hospitalization.”

“Sounds great,” Traynor said with enthusiasm. “Let’s pursue it. Maybe this kind of program, combined with DUM, will eliminate the red ink.”

“I’ll arrange a meeting with Charles Kelley to discuss it,” Beaton said as she got her coat.

“While we’re on the topic of utilization,” Beaton said as they started down the long hall toward the exit, “I hope to heaven that we’re not going to get the Certificate of Need for open-heart surgery. It’s crucial we don’t. We have to keep CMV sending their bypass patients to Boston.”

“I agree wholeheartedly,” Traynor said as he held the door open for Beaton. They passed out of the hospital into the lower parking area. “That was one of the reasons I was in Montpelier today. I’ve started some behind-the-scenes negative lobbying.”

“If we get that CON we’ll be looking at a lot more red ink,” Beaton warned.

They arrived at their respective cars which were parked side by side. Before he climbed behind the wheel, Traynor glanced around the dark parking area, particularly up toward the copse of trees that separated the lower lot from the upper.

“It’s darker out here than I remembered,” he called over to Beaton. “It’s like asking for trouble. We need those lights.”

“I’ll get right on it,” she promised.

“What a pain!” Traynor said. “With everything else we have to worry about, we’ve got to worry about a damn rapist. What are the details about last night’s episode?”

“It occurred about midnight,” Beaton said. “And this time it wasn’t a nurse. It was one of the volunteers, Marjorie Kleber.”

“The teacher?” Traynor asked.

“That’s right,” Beaton said. “Ever since she got sick herself she’s been doing a lot of volunteering on weekends.”

“How about the rapist?” Traynor asked.

“Same description: about six feet, wearing a ski mask. Ms. Kleber said he had handcuffs.”

“That’s a nice touch,” Traynor said. “How’d she get away?”

“It was just lucky,” Beaton said. “The night watchman just happened along while making his rounds.”

“Maybe we should beef up security,” Traynor suggested.

“That’s money we don’t have,” Beaton reminded him.

“Maybe I should talk to Wayne Robertson and see if the police can do any more,” Traynor said.

“I’ve already done that,” Beaton said. “But Robertson doesn’t have the manpower to have someone up here every night.”

“I wonder if Hodges really did know the rapist’s identity?”

“Do you think his disappearance could have had anything to do with his suspicions?” Beaton asked.

Traynor shrugged. “I hadn’t thought of that. I suppose it’s possible. He wasn’t one to keep his opinion to himself.”

“It’s a scary thought,” Beaton said.

“Indeed,” Traynor said. “Regardless, I want to be informed about any such assaults immediately. They can have disastrous consequences for the hospital. I especially don’t want any surprises at an executive board meeting. It makes me look bad.”

“I apologize,” Beaton said, “but I did try to call. From now on I’ll make sure you are informed.”

“See you down at the Iron Horse,” Traynor said as he got into his car and started the engine.

“I’ve got to leave to pick up my child from her after-school program,” Angela said to one of her fellow residents, Mark Danforth.

“What are you going to do about all these slides?” Mark asked.

“What can I do?” Angela snapped. “I’ve got to get my daughter.”

“Okay,” Mark said. “Don’t jump on me. I was only asking. I thought maybe I could help.”

“I’m sorry,” Angela said. “I’m just strung out. If you could just see these few I’d be forever in your debt.” She picked five slides from the rack.

“No problem,” Mark said. He added Angela’s to his own stack.

Angela covered her microscope, grabbed her things, and ran out of the hospital. No sooner had she pulled out of the lot than she was bogged down in rush-hour Boston traffic.

When Angela finally pulled up to the school, Nikki was sitting forlornly on the front steps. It was not a pretty area. The school was awash with graffiti and surrounded by a sea of concrete. Except for a group of sixth- and seventh-graders shooting baskets beyond a high chain-link fence, there were no grammar-school-aged children in sight. A group of listless teenagers in ridiculously oversized clothing loitered alongside the building. Directly across the street was the cardboard shanty of a homeless person.

“I’m sorry I was late,” Angela said as Nikki climbed into the car and plugged in her seat belt.

“It’s all right,” Nikki said, “but I was a little scared. There was a big problem in school today. The police were here and everything.”

“What happened?”

“One of the sixth-grade boys had a gun in the playground,” Nikki said calmly. “He shot it and got arrested.”

“Was anybody hurt?”

“Nope,” Nikki said with a shake of her head.

“Why did he have a gun?” Angela asked.

“He’s been selling drugs,” Nikki replied.

“I see,” Angela said, trying to maintain her composure as well as her daughter could. “How did you hear about this? From the other kids?”

“No, I was there,” Nikki said, suppressing a yawn.

Angela’s grip on the steering wheel involuntarily tightened. Public school had been David’s idea. The two of them had gone to considerable effort in choosing the one that Nikki attended. Up until this episode, Angela had been reasonably satisfied. But now she was appalled, partly because Nikki was able to talk about the incident so matter-of-factly. It was frightening to realize that Nikki viewed this as an ordinary event.

“We had a substitute again today,” Nikki said. “And she wouldn’t let me do my postural lung drainage after lunch.”

“I’m sorry, dear,” Angela said. “Do you feel congested?”

“Some,” Nikki said. “I was wheezing a little after being outside, but it went away.”

“We’ll do it as soon as we get home,” Angela said. “And I’ll call the school office again, too. I don’t know what their problem is.”

Angela did know what the problem was: too many kids and not enough staff, and what staff they had was always changing. Every few months Angela had to call to tell them about Nikki’s need for respiratory therapy.

While Nikki waited in the car, Angela double-parked and dashed into the local grocery store for something to make for dinner. When she came out there was a parking ticket under the windshield wiper.

“I told the lady you’d be right out,” Nikki explained, “but she said ‘Tough’ and gave it to us anyway.”

Angela cursed under her breath.

For the next half hour they cruised around their immediate neighborhood looking for a parking space. Just when Angela was about ready to give up they found a spot.

After putting cold groceries in the refrigerator, Angela and Nikki attended to Nikki’s respiratory physiotherapy. Usually they only did it in the morning. But on certain days, usually those with heavy pollution, they had to do it more often.

The routine they had established started with Angela listening with her stethoscope to make sure Nikki didn’t need a bronchodilating drug. Then, by using a large beanbag chair that they’d bought at a garage sale, Nikki would assume nine different positions that utilized gravity to help drain specific areas of her lungs. While Nikki held each position, Angela percussed over the lung area with a cupped hand. Each position took two or three minutes. In twenty minutes they were finished.

With the respiratory therapy done, Nikki turned to her homework while Angela went into the galley-like kitchen to start dinner. A half hour later David came home. He was exhausted, having been up the entire previous night attending a number of sick patients.

“What a night!” he said. He tried to give Nikki a kiss on the cheek, but she pulled away, concentrating on her book. She was sitting at the dining-room table. Her bedroom wasn’t large enough for a desk.

David stepped into the kitchen and was similarly rebuffed by Angela, who was busy with the dinner preparations. Twice spurned, David turned to the refrigerator. After having some difficulty getting the door open with both him and Angela in the same small area, he pulled out a beer.

“We had two AIDS patients come in through the ER with just about every disease known to man,” he said. “On top of that, there were two cardiac arrests. I never even got to see the inside of the on-call room, much less get any sleep.”

“If you’re looking for sympathy you’re talking to the wrong person,” Angela said as she put some pasta on to boil. “You are also in my way.”

“You’re in a great mood,” David said. He moved out of the tiny kitchen and draped himself over one of the stools at the counter that separated the kitchen from the living and dining area.

“My day has been stressful too,” she said. “I had to leave unfinished work in order to pick Nikki up from school. I don’t think it’s fair that I have to do it every day.”

“So this is what you’re hysterical about?” David said. “Picking Nikki up? I thought that had been discussed and decided. Hell, you’re the one who offered, saying your schedule was so much more predictable than mine.”

“Can’t you two be more quiet?” Nikki said. “I’m trying to read.”

“I’m not hysterical!” Angela snapped sotto voce. “I’m just stressed out. I don’t like depending on others to do my work. And on top of that, Nikki had some disturbing news today.”

“Like what?” David asked.

“Ask her,” Angela said.

David slipped off the barstool and squeezed into one of the dining-room chairs. Nikki told him about her day. Angela came into the room and began setting the table around Nikki’s books.

“Are you still as supportive of public school when you hear about guns and drugs in the sixth grade?” Angela asked.

“Public schools have to be supported,” David said. “I went to public school.”

“Times have changed,” Angela said.

“If people like us run away,” David said, “the schools don’t have a chance.”

“I’m not willing to be idealistic when it comes to my daughter’s safety,” Angela snapped.

Once dinner was ready, they ate their spaghetti marinara and salads in strained silence. Nikki continued to read, ignoring her parents. Angela sighed loudly several times and ran her fingers through her hair. She was on the verge of tears. David fumed. After working as hard as he had for the previous thirty-six hours he did not think he deserved this kind of treatment.

Angela suddenly scraped back her chair, picked up her dish, and dropped it into the sink. It broke and both David and Nikki jumped.

“Angela,” David said, struggling to keep his voice under control. “You’re being overly emotional. Let’s talk about picking Nikki up. There has to be another solution.”

Angela wiped a few wayward tears from the corners of her eyes. She resisted the temptation to lash back at David and tell him that his conception of himself as the rational, agreeable partner was hardly reality.

Angela turned around from facing the sink. “You know,” she said, “the real problem is that we have been avoiding making a decision about what to do come July first.”

“I hardly think this is the opportune time to discuss what we are going to do with the rest of our lives,” David said. “We’re exhausted.”

“Oh, beans,” Angela said. She returned to the table and took her seat. “You never think it’s the right time. The problem is time is running out, and no decision is a decision of sorts. July first is less than a month and a half away.”

“Okay,” David said with resignation. “Let me get my lists.” He started to get up. Angela restrained him.

“We hardly need your lists,” Angela said. “We have three choices. We’ve been waiting for New York to respond and they did three days ago. Here are our choices in a nutshell: we can go to New York and I’ll start a fellowship in forensics and you in respiratory medicine; we can stay here in Boston where I’ll do forensics and you’ll go to the Harvard School of Public Health; or we can go to Bartlet and start to work.”

David ran his tongue around the inside of his mouth. He tried to think. He was numb from fatigue. He wanted his lists, but Angela still had a hold on his arm.

“It’s a little scary leaving academia,” David said finally.

“I couldn’t agree more,” Angela said. “We’ve been students for so long it’s hard to think of any other life.”

“It’s true we’ve had little personal time over these last four years,” he said.

“Quality of life has to become an issue at some point,” Angela agreed. “The reality is that if we stay here in Boston we’ll probably have to stay in this apartment. We have too much debt to do anything else.”

“It would be about the same if we went to New York,” David said.

“Unless we accepted help from my parents,” Angela said.

“We’ve avoided that in the past,” David reminded her. “There have always been too many strings attached to their help.”

“I agree,” Angela said. “Another thing that we have to consider is Nikki’s condition.”

“I want a dog,” Nikki said.

“Nikki’s been doing okay,” David said.

“But there’s a lot of pollution here and in New York,” Angela said. “That’s bound to take its toll. And I’m getting pretty tired of all the crime here in the city.”

“Are you saying you want to go to Bartlet?” David asked.

“No,” Angela said, “I’m just trying to think of all the issues. But I have to admit, when I hear about guns and drugs in the sixth grade, Bartlet starts to sound better and better.”

“I wonder if it is as heavenly as we remember,” David questioned. “Since we go so few places maybe we’ve idealized it too much.”

“There’s one way to find out,” Angela said.

“Let’s go back!” Nikki cried.

“All right,” David said. “Today’s Thursday. How about Saturday?”

“Sounds good to me,” Angela said.

“Yippee!” Nikki said.

Traynor signed all the letters he’d dictated that morning and piled them neatly on the corner of his desk. Eagerly he got up and pulled on his coat. He was on his way through the outer office en route to the Iron Horse for lunch when his secretary, Collette, called him back to take a call from Tom Baringer.

Muttering under his breath, Traynor returned to his desk. Tom was too important a client to miss his call.

“You’ll never guess where I am,” Tom said. “I’m in the emergency room waiting for Dr. Portland to come in to put me back together.”

“My God, what happened?” Traynor asked.

“Something stupid,” Tom admitted. “I was cleaning some leaves out of my gutters when the ladder I was on fell over. I broke my damn hip. At least that’s what the doctor tells me here in the emergency room.”

“I’m sorry,” Traynor said.

“Oh, it could be worse,” Tom said. “But obviously I won’t be able to make the meeting we had scheduled for this afternoon.”

“Of course,” Traynor said. “Was there something important you wanted to discuss?”

“It can wait,” Tom said. “But listen, as long as I have you on the phone, how about giving the powers that be here at the hospital a call. I figure I deserve some VIP attention.”

“You got it,” Traynor said. “I’ll see to it personally. I’m just on my way out to have lunch with the hospital’s CEO.”

“Good timing,” Tom said. “Put in the good word.”

After hanging up, Traynor told his secretary to cancel Tom’s appointment and leave the slot open. The break would give him a chance to catch up on dictation.

Traynor was first to arrive for his luncheon meeting. After ordering a dry martini, he scanned the beam-ceilinged room. As usual of late, he’d been given the best table in the house, one in a cozy bay with a particularly dramatic view of the Roaring River which raced past the rear of the inn. Traynor’s pleasure was enhanced when he saw Jeb Wiggins, his old rival and a scion of one of the few old moneyed families of Bartlet, sitting at a far less conspicuous table. Jeb had always treated Traynor with condescension. Traynor’s father had worked in the coat-hanger factory, which at that time had been one of the Wigginses’ holdings. Traynor relished the role reversal: now he was running the biggest business in town.

Helen Beaton and Barton Sherwood arrived together. “Sorry we’re late,” Sherwood said, holding back Beaton’s chair.

Beaton and Sherwood were served their usual drinks and they all ordered their meals. As soon as the waiter left them, Beaton spoke: “I have some good news. I met with Charles Kelley this morning, and he has no problem with our idea of instituting a bonus program for the CMV doctors. His only concern is whether it would cost CMV anything, which it won’t. He promised to run the idea past his bosses, but I don’t anticipate any problem.”

“Wonderful,” Traynor said.

“We’ll be meeting again on Monday,” Beaton added. “I’d like you to attend if you have the time.”

“By all means,” Traynor said.

“Now all we need is the start-up capital,” Beaton said. “So I met with Barton and I think we have it solved.” Beaton gave Sherwood’s arm a squeeze.

Sherwood leaned forward and spoke in hushed tones: “Remember that small slush fund we’d created with the kickbacks from the construction on the radiotherapy building? I’d deposited it in the Bahamas. What I’ll do is bring it back in small increments as needed. Also we can use some of it for vacations in the Bahamas. That’s the easiest. We can even pay for the air tickets in the Bahamas.”

The food arrived and no one spoke until the waitress had departed.

“We thought a vacation in the Bahamas could function as a grand prize,” Beaton explained. “It could be awarded to the doctor with the lowest hospitalization percentage for the year.”

“That’s perfect,” Traynor said. “This whole idea is sounding better and better.”

“We’d better get it up and running ASAP,” Beaton said. “So far the May figures are worse than those for April. Admissions are higher and the money loss correspondingly greater.”

“I have some good news,” Sherwood said. “The hospital sinking fund is back to its projected level with the infusion of the cash from the insurance bequest. It was done in a way that none of the bond examiners will ever detect.”

“It’s just one crisis after another,” Traynor complained. He wasn’t about to give Sherwood credit for fixing a problem he’d created.

“Do you want me to go ahead with the bond issue for the parking garage?” Sherwood asked.

“No,” Traynor answered. “Unfortunately, we can’t. We have to go back to the Board of Selectmen for another vote. Their approval had been contingent on starting the project immediately.” With a scornful expression Traynor gestured with his head toward a neighboring table. “The Selectmen’s chairman, Jeb Wiggins, thinks the tourist season might get screwed up if we build during the summer.”

“How unfortunate,” Sherwood said.

“I’ve got a bit of good news myself,” Traynor added. “I just heard this morning that our CON for open-heart surgery has been turned down for this year. Isn’t that terrible?”

“Oh, what a tragedy,” Beaton said with a laugh. “Thank God!”

After the coffee had been served, Traynor remembered the call from Tom Baringer. He relayed the information on to Beaton.

“I’m already aware of Mr. Baringer’s admission,” Beaton said. “Some time ago I programmed a tickler file into the computer to alert me when such a patient is hospitalized. I’ve already spoken to Caldwell and he’ll be taking care to be sure Mr. Baringer gets proper VIP treatment. What’s the value of the fund?”

“One million,” Traynor said. “It’s not huge, but nothing to scoff at.”

After they had finished their lunch, they walked out into the bright late spring sunshine.

“What’s the status on the lighting of the parking lots?” Traynor asked.

“It’s all done,” Beaton said. “It’s been done for over a week. But we decided to restrict the lighting to the lower lot. The upper is used only during the day, and by doing only the lower, we saved a considerable amount of money.”

“Sounds reasonable,” Traynor said.

Close to the Green Mountain National Bank they ran into Wayne Robertson. His wide-brimmed, trooper style hat was low on his forehead to shield his eyes from the sun. As added protection he was wearing highly reflective sunglasses.

“Afternoon,” Traynor said amicably.

Robertson touched the brim of his hat in a form of salute.

“Any startling developments in the Hodges case?” Traynor asked.

“Hardly,” Robertson said. “In fact, we’re thinking about dropping it.”

“I wouldn’t be too premature,” Traynor warned. “Remember, that old geezer had a penchant for appearing when least expected.”

“And unwanted,” Beaton added.

“Dr. Cantor thinks he’s in Florida,” Robertson said. “I’m starting to believe it myself. I think that little scandal about the hospital taking care of his house embarrassed him enough to leave town.”

“I would have thought he’d have thicker skin than that,” Traynor said. “But who am I to guess.”

After exchanging farewells and good wishes for the weekend, the four returned to their respective jobs.

As Beaton drove up the hill toward the hospital, she thought about Traynor and her relationship with him. She wasn’t happy; she wanted more. Trysts once or twice a month were hardly what she’d expected.

Beaton had met Traynor several years previously when he’d come to Boston to take a refresher course in tax law. She’d been working in the city as an assistant administrator in one of the Harvard hospitals. The attraction was instantaneous and mutual. They spent a torrid week together, then rendezvoused intermittently until he’d recruited her to come to Bartlet to run the hospital. She’d been led to believe that they would eventually live together, but so far it hadn’t happened. Traynor had not gotten the divorce he’d promised was imminent. Beaton felt she had to do something to rectify the situation; she just didn’t know what.

Back at the hospital, Beaton went directly to room 204, where she expected to find Tom Baringer. She intended to make sure he was comfortable. He wasn’t there. Instead Beaton was surprised to discover another patient: a woman by the name of Alice Nottingham. Beaton set her jaw, descended to the first floor, and marched into Caldwell’s office.

“Where’s Baringer?” she asked curtly.

“Room 204,” Caldwell said.

“Unless Mr. Baringer has had a sex change operation and is going by the name of Alice, he’s not in 204.”

Caldwell quickly got to his feet. “Something’s gone wrong.” He pushed past Beaton and hurried across the hall to admissions. There he sought out Janice Sperling and asked her what had happened to Tom Baringer.

“I put him in 209,” Janice said.

“I told you to put him in 204,” Caldwell said.

“I know,” Janice admitted. “But since we talked, 209 came available. It’s a larger room. You said Mr. Baringer was a special patient. I thought he’d like 209 better.”

“204 has a better view, plus it has the new orthopedic bed,” Caldwell said. “The man has a broken hip. Either change rooms or change beds.”

“Okay,” Janice said, rolling her eyes. Some people could never be pleased.

Caldwell went to Beaton’s office and stuck his head through the door. “I’m sorry for not having followed up on that situation,” he said. “But it will be rectified within the hour. I promise.”

Beaton nodded and went back to her work.