David had set the alarm for five forty-five as if it were a normal workday. By six-fifteen he was on his way to the hospital. The temperature had already climbed into the low seventies and the skies were clear. Before nine he was finished with his rounds and on his way home.

“Okay, you guys,” he called as he entered the apartment. “I don’t want to spend this whole day waiting. Let’s get this show on the road.”

Nikki appeared in her doorway. “That’s not fair, Daddy. We’ve been waiting for you.”

“Just kidding,” David said with a laugh as he gave Nikki a playful tickle.

Soon they were off. Before long, urban sprawl gave way to tree-dotted suburbia followed by long stretches of forest. The farther north they went, the prettier the surroundings became, especially now that leaves were on the trees.

When they reached Bartlet, David slowed to a crawl. Like eager tourists they drank in the sights.

“This is even more picturesque than I remembered,” Angela said.

“There’s that same puppy!” Nikki cried. She pointed across the street. “Can we stop?”

David pulled into an empty diagonal parking slot. “You’re right,” he said. “I recognize the lady.”

“I recognize the dog,” Nikki said. She opened the car door and got out.

“Just a second,” Angela called. She jumped out of the car and took Nikki’s hand to cross the street. David followed.

“Hello again,” the woman said when Nikki approached. The puppy caught sight of Nikki and strained at its leash. As Nikki bent down, the dog licked her face. Nikki laughed with surprise.

“I don’t know if you’d be interested, but Mr. Staley’s retriever just had puppies a few weeks ago,” the woman said. “They’re right over in the hardware store across the street.”

“Can we go see them?” Nikki pleaded.

“Why not,” David said. He thanked the woman.

Recrossing the street the Wilsons entered the hardware store. Near the front in a makeshift playpen was Mr. Staley’s dog, Molly, suckling five floppy puppies.

“They’re adorable,” Nikki cried. “Can I pet them?”

“I don’t know,” David said. He turned to look for a store attendant and practically bumped into Mr. Staley, who was standing directly behind them.

“Sure, she can pet them,” Mr. Staley said after introducing himself. “In fact, they’re for sale. No way I need six golden retrievers.”

Nikki collapsed on her knees and, reaching into the pen, gently stroked one of the puppies. He responded by attaching himself to Nikki’s finger as if it were a teat. Nikki squealed with delight.

“Pick him up if you like,” Mr. Staley said. “He’s the brute of the litter.”

Nikki scooped the puppy up in her arms. The tiny dog snuggled against her cheek and licked her nose.

“I love him,” Nikki said. “I wish we could get him. Can we? I’ll take care of him.”

David felt an unexpected surge of tears that he had to forcibly suppress. He took his eyes off Nikki and looked at Angela. Angela dabbed a tissue into the corners of her eyes and glanced up at her husband. Their eyes met in a moment of complete understanding. Nikki’s modest request affected them even more than it had on their first visit to Bartlet. Considering all that she’d been through with her cystic fibrosis, it wasn’t much to ask for.

“Are you thinking what I’m thinking?” David asked.

“I think so,” Angela said. Her tears gave way to a smile. “It would mean we could buy a house.”

“Goodbye, crime and pollution,” he said. He looked down at Nikki. “Okay,” he said. “You can have the dog. We’re moving to Bartlet!”

Nikki’s face lit up. She hugged the puppy to her chest as it licked her face.

David turned to Mr. Staley and settled on a price.

“I figure they will be ready to leave the mother in four weeks or so,” Mr. Staley said.

“That will be perfect,” David said. “We’ll be coming up here at the end of the month.”

With some difficulty, Nikki was separated from her puppy, and the Wilsons went back outside.

“What will we do now?” Angela asked with excitement.

“Let’s celebrate,” David said. “Let’s have lunch at the inn.”

A few minutes later they were sitting at a cloth-covered table with a view of the river. David and Angela each ordered a glass of white wine. Nikki had a cranberry juice. They touched their glasses.

“I’d like to toast our arrival in the Garden of Eden,” David said.

“And I’d like to toast the beginning of paying back our debt,” Angela said.

“Hear, hear!” David said, and they drank.

“Can you believe it?” Angela asked. “Our combined income will be over one hundred and twenty thousand dollars.”

David sang a few bars of the song “We’re in the Money.”

“I think I’ll call my dog Rusty,” Nikki said.

“That’s a wonderful name,” David said.

“What do you think about me earning twice what you do?” Angela teased.

David had known the barb would come at some point so he was prepared. “You’ll be earning it in your dark, dreary lab,” he teased back. “At least I’ll be seeing real, live, appreciative people.”

“Won’t it challenge your delicate masculinity?” Angela continued.

“Not in the slightest,” David said. “Also it’s nice to know that if we ever get divorced I’ll get alimony.”

Angela lunged across the table to give David a poke in the ribs.

David parried Angela’s playful gesture. “Besides,” he said, “that kind of differential won’t last much longer. It’s a legacy of a past era. Pathologists, like surgeons and other overpaid specialists, will soon be brought down to earth.”

“Says who?” Angela demanded.

“Says me,” David said.

After lunch, they decided to go straight to the hospital to let Caldwell know their decision. Once they presented themselves to his secretary, they were ushered in right away.

“That’s fantastic!” Caldwell said when they informed him of their decision. “Does CMV know yet?” he asked.

“Not yet,” David said.

“Come on,” Caldwell said. “Let’s go give them the good news.”

Charles Kelley was equally pleased with the news. After a congratulatory handshake he asked David when he thought he’d be ready to start seeing patients.

“Just about immediately,” David said without hesitation. “July first.”

“Your residency isn’t over until the thirtieth,” Kelley said. “Don’t you want some time to get settled?”

“With our debt,” David said, “the sooner we start working the better we’ll feel.”

“Same for you?” Caldwell asked Angela.

“Absolutely,” Angela answered.

David asked if they could go back to the office he’d be assigned. Kelley was happy to oblige.

David paused outside the waiting room door, fantasizing how his name would look in the empty slot under Dr. Randall Portland’s name. It had been a long, hard road, starting from the moment in the eighth grade when he’d decided to become a doctor, but he’d finally made it.

David opened the door and stepped over the threshold. His reverie was broken when a figure dressed in surgical scrubs leaped off the waiting room couch.

“What is the meaning of this?” the man angrily demanded.

It took David a moment to recognize Dr. Portland. It was partly due to the unexpectedness of the encounter, but it was also because Dr. Portland had changed in the month since David had last seen him. He’d lost considerable weight; his eyes seemed sunken, even haunted, and his cheeks were gaunt.

Kelley pushed his way to the front of the group, reintroduced David and Randall, and then explained to Randall why they were there. Dr. Portland’s anger waned. Like a balloon losing its air, he collapsed back onto the couch. David noticed that not only had Randall lost weight but he was pale.

“Sorry to have bothered you,” David said.

“I was just getting a bit of sleep,” Dr. Portland explained. His voice was flat. He sounded as exhausted as he looked. “I did a case this morning, and I felt tired.”

“Tom Baringer?” Caldwell asked.

Dr. Portland nodded.

“I hope it went okay,” Caldwell said.

“The operation went fine,” Dr. Portland said. “Now we have to keep our fingers crossed for the post-op course.”

David apologized again, then herded everyone, including himself, out of the office.

“Sorry about that,” Kelley said.

“What’s wrong with him?” David asked.

“Nothing that I know of,” Kelley said.

“He doesn’t look well,” David said.

“I thought he looked depressed,” Angela said.

“He’s busy,” Kelley admitted. “I’m sure he’s just overworked.”

The group stopped outside Kelley’s office. “Now that we know you are coming,” Kelley said, “is there anything that we can do to help?”

“We’ll have to go look at a few houses,” Angela said. “Who do you suggest we call?”

“Dorothy Weymouth,” Caldwell said.

“He’s right,” Kelley said.

“She’s far and away the best realtor in town,” Caldwell added. “Come back to my office and use my phone.”

A half hour later, the whole family was in Dorothy Weymouth’s office on the second floor of the building across the street from the diner. She was a huge, pleasant woman attired in a shapeless, tent-like dress.

“I have to tell you, I’m impressed,” Dorothy said. Her voice was surprisingly high-pitched for such a large woman. “While you were on your way over here from the hospital, Barton Sherwood called to tell me the bank is eager to help you. Now it doesn’t happen often that the president of the bank calls before I’ve even met the client.

“I’m not sure exactly what your tastes are,” Dorothy said as she began putting photos of properties currently on the market out on her desk. “So you’ll have to help me. Do you think you’d like a white clapboard house in town or an isolated stone farmhouse? What about size? Is that an important consideration? Are you planning any more children?”

Both David and Angela tensed at the question of whether they would have more children. Until Nikki’s birth, neither had suspected they were carriers of the cystic fibrosis gene. It was a reality they could not ignore.

Unaware she’d hit a nerve, Dorothy continued laying out photos of homes, while she maintained a steady monologue.

“Here’s a particularly charming property that’s just come on the market. It’s a beauty.”

Angela caught her breath. She picked up the photo. Nikki tried to look over her shoulder.

“I do like this one,” Angela said. She handed the picture to David. It was a brick, late Georgian or early Federal style home with double bow windows on either side of a central, paneled front door. Fluted white columns held up a pedimented portico over the door. Above the pediment was a large Palladian window.

“That’s one of the oldest brick homes in the area,” Dorothy said. “It was built around 1820.”

“What’s this in the back?” David asked, pointing to the photo.

Dorothy looked. “That’s the old silo,” she said. “Behind the house and connected to it is a barn. You can’t see the barn in that photo because the picture was taken directly in front of the house, down the hill. The property used to be a dairy farm, quite a profitable one, I understand.”

“It’s gorgeous,” Angela said wistfully. “But I’m sure we could never afford it.”

“You could according to what Barton Sherwood told me,” Dorothy said. “Besides, I know that the owner, Clara Hodges, is very eager to sell. I’m sure we could get you a good deal. Anyway, it’s worth a look. Let’s pick four or five others and go see them.”

Cleverly orchestrating the order of the visits, Dorothy left the Hodges house for last. It was located about two and a half miles south of the town center on the crest of a small hill. The nearest house was an eighth of a mile down the road. When they pulled into the driveway, Nikki noticed the frog pond and was immediately sold.

“The pond is not only picturesque,” Dorothy said, “it’s also great for skating in the wintertime.”

Dorothy pulled to a halt between the house and the frog pond and slightly to the side. From there they had a view of the structure with its connected barn. Neither Angela nor David said a word. They were both awed by the home’s noble and imposing character. They now realized that the house was three stories instead of two. They could see four dormers on each side of the pitched slate roof.

“Are you sure Mr. Sherwood thinks we can afford this?” David asked.

“Absolutely,” Dorothy said. “Come on, let’s see the interior.”

In a state of near hypnosis, David and Angela followed Dorothy around the inside of the house. Dorothy continued her steady stream of realtor chatter, saying things like “This room has so much promise” and “With just a little creativity and work, this room would be so cozy.” Any problems such as peeling wallpaper or dry-rotted window sashes she minimized. The good points, like the sizes of the many fireplaces and the beautiful cornice work, she lauded with an uninterrupted flow of superlatives.

David insisted on seeing everything. They even descended the gray granite steps into the basement, which seemed exceptionally damp and musty.

“There seems to be a strange smell,” he said. “Is there a water problem down here?”

“Not that I’ve heard of,” Dorothy said. “But it is a nice big basement. There’s room enough for a shop if you’re the handy type.”

Angela suppressed a giggle as well as a disparaging comment. She’d been about to say that David had trouble changing light bulbs, but she held her tongue.

“There’s no floor,” David said. He bent down and pried up a bit of dirt with his fingernail.

“It’s a packed earth floor,” Dorothy explained. “It’s common in older homes like this. And this basement has other features typical of a nineteenth-century dwelling.” She pulled open a heavy wooden door. “Here’s the old root cellar.”

There was shelving for preserves and bins for potatoes and apples. The room was poorly lit with one small bulb.

“It’s scary,” Nikki said. “It’s like a dungeon.”

“This will be handy if your parents ever come to visit,” David said. “We can put them up down here.”

Angela rolled her eyes.

After showing them the root cellar, Dorothy took them over to the other corner of the basement and proudly pointed out a large freezer chest. “This house has both the old and the new methods of food storage,” she said.

Before they left the basement Dorothy opened a second door. Behind it was a second flight of granite steps which led up to a hatch-like door. “These stairs lead out to the back yard,” Dorothy explained. “That’s why the firewood is here.” She pointed to several cords of firewood neatly stacked against the wall.

The last thing of note in the basement was the huge furnace. It looked almost like an old-fashioned steam locomotive. “This used to burn coal,” Dorothy explained, “but it was converted to oil.” She pointed out a large fuel tank perched on cinder blocks in the corner opposite the freezer chest.

David nodded, though he didn’t know much about furnaces no matter what they burned.

On the way back up the steps to the kitchen, David smelled the musty smell again and asked about the septic system.

“The septic system is fine,” Dorothy said. “We had it inspected. It’s to the west of the house. I can point out the leach field if you like.”

“As long as it’s been inspected, I’m sure it’s okay,” David said. He had no idea what a leach field was or what it should look like.

David and Angela had Dorothy drop them off at the Green Mountain National Bank. They were nervous and excited at the same time. Barton Sherwood saw them almost immediately.

“We found a house that we like,” David said.

“I’m not surprised,” Sherwood said. “There are lots of wonderful houses in Bartlet.”

“It’s a house owned by Clara Hodges,” David continued. He handed over the real estate summary sheet. “The asking price is two hundred and fifty thousand dollars. What does the bank think about the property and the price?”

“It’s a great old house,” Sherwood said. “I know it well.” He scanned the summary sheet. “And the location is fabulous. In fact it borders my own property. As far as the price is concerned, I think it’s a steal.”

“So the bank would be willing to underwrite our purchase at that price?” Angela questioned. She wanted to be sure. It seemed too good to be true.

“Of course, you’ll offer less,” Sherwood said. “I’d suggest an initial offer of one hundred and ninety thousand. But the bank will be willing to back the purchase up to the asking price.”

Fifteen minutes later David, Angela, and Nikki stepped back out into the warm Vermont sunshine. They had never bought a house before. It was a monumental decision. Yet having decided to come to Bartlet they were in a decisive frame of mind.

“Well?” David asked.

“I can’t imagine finding something we’d like better,” Angela said.

“I can even have a desk in my room,” Nikki said.

David reached out and tousled Nikki’s hair. “With as many rooms as that house has, you can have your own study.”

“Let’s do it,” Angela said.

Back in Dorothy’s office they told the pleased realtor their decision. A few minutes later Dorothy had Clara Hodges on the phone, and although it was a bit unconventional, a deal was concluded orally at a price of two hundred and ten thousand dollars.

As Dorothy drew up the formal documents, David and Angela exchanged glances. They were stunned to realize they were the new owners of a home more gracious than they could have ever hoped to have owned for years to come. Yet there was some anxiety as well. Their debt had more than doubled, to over three hundred and fifty thousand dollars.

By the end of the day, after a bit of shuttling back and forth between Dorothy’s office and the bank, all the appropriate papers were filled out and a closing date was set.

“I have some names for you,” Dorothy said when they were through with the paperwork. “Pete Bergan does odd jobs around the town. He’s not the world’s smartest fellow, but he does good work. And for painting, I use John Murray.”

David wrote the names down with their phone numbers.

“And if you need a sitter for Nikki, my older sister, Alice Doherty, would be delighted to help out. She lost her husband a few years ago. Besides, she lives out your way.”

“That’s a wonderful tip,” Angela said. “With both of us working we’ll need someone just about every day.”

Later that same afternoon David and Angela met the handyman and the painter out at their new home. They arranged to have a general cleaning as well as a minimum of painting and repairing to make the house weatherproof.

After one more visit to the hardware store so Nikki could pet Rusty one last time and say goodbye, the Wilsons got on the road for the drive back to Boston. Angela drove. Neither David nor Nikki dozed. They were all keyed up from what they’d accomplished and full of dreams about their new life that was imminently to begin.

“What did you think about Dr. Portland?” David asked after a period of silence.

“What do you mean?” said Angela.

“The man was hardly friendly,” David said.

“I think we woke him up.”

“Still, most people wouldn’t act that irritable. Besides, he looked like death warmed over. He’s changed so drastically in a month.”

“I thought he sounded and looked depressed.”

David shrugged. “He wasn’t even that friendly the first time we met him, now that I think of it. All he wanted to know was whether I played basketball. Something about him makes me feel uncomfortable. I hope sharing an office with him doesn’t become a sore spot.”

It was dark by the time they returned to Boston; they’d stopped for dinner on the way. When they got back to their apartment, they looked around in wonderment, amazed that they’d been able to live for four years in such a tiny, claustrophobic space.

“This entire apartment would fit into the library of the new house,” Angela commented.

David and Angela decided to call their parents to share the excitement. David’s were delighted. Having retired to Amherst, New Hampshire, they felt like Bartlet was next door. “We’ll get to see a lot more of you guys,” they said.

Angela’s parents had a different response.

“It’s easy to drop out of the academic big leagues,” Dr. Walter Christopher said. “But it’s hard getting back in. I think you could have asked my opinion before you made such a foolish move. Here’s your mother.”

Angela’s mother came on the line and expressed her disappointment that Angela and David hadn’t come to New York. “Your father spent a lot of time talking to all sorts of people to make sure you had good positions here,” she said. “I think it was inconsiderate of you not to take advantage of his effort.”

After Angela hung up she turned to David. “They’ve never been particularly supportive,” she said. “So I suppose I shouldn’t have expected them to change now.”

Traynor arrived at the hospital with time to spare for his afternoon meeting. Instead of going directly to Helen Beaton’s office, he went to the patient area on the second floor and walked down to room 209. After taking a breath to fortify himself, he pushed the door open. Being chairman of the board of directors of the hospital had not changed Traynor’s aversion to medical situations, particularly bad medical situations.

Conscious of breathing shallowly in the presence of the seriously ill, Traynor moved across the darkened room and approached the large orthopedic bed. Bending over and scrupulously avoiding touching anything, he peered at his client, Tom Baringer. Tom didn’t look good, and Traynor didn’t want to get too close lest he catch some awful illness. Tom’s face was gray and his breathing was labored. A plastic tube snaked from behind his head, feeding oxygen into his nose. His eyes were closed with tape, and ointment oozed out between his eyelids.

“Tom,” Traynor called softly. When there was no response, he called louder. But Tom did not move.

“He’s beyond responding.”

Traynor jumped and the blood drained from his own face. Except for Tom, he’d thought he was alone.

“His pneumonia is not responding to treatment,” the stranger said angrily. He’d been sitting in a corner of the room. He was cloaked in shadows; Traynor could not see his face.

“He’s dying like the others,” the man said.

“Who are you?” Traynor asked. He wiped his forehead where perspiration had instantly appeared.

The man got to his feet. Only then could Traynor see that he was dressed in surgical scrubs, covered with a white jacket.

“I’m Mr. Baringer’s doctor, Randy Portland.” He advanced to the opposite side of the bed and gazed down at his comatose patient. “The operation was a success but the patient is about to die. I suppose you’ve heard a variation of that quip before.”

“I suppose I have,” Traynor said nervously. Shock at Dr. Portland’s presence was changing to anxious concern. There was something decidedly strange about the man’s manner. Traynor wasn’t sure what he would do next.

“The hip has been repaired,” Dr. Portland said. He lifted the edge of the sheet so Traynor could see the tightly sutured wound. “No problem whatsoever. But unfortunately it’s been a fatal cure. There’s no way Mr. Baringer will walk out of here.” Portland dropped the sheet and defiantly raised his eyes to Traynor’s. “There’s something wrong with this hospital,” he said. “I’m not going to take all the blame.”

“Dr. Portland,” Traynor said hesitantly. “You don’t look well to me. Maybe you should see a doctor yourself.”

Dr. Portland threw back his head and laughed. But it was a hollow, mirthless laugh which ended as suddenly as it had begun. “Maybe you’re right,” he said. “Maybe I’ll do that.” He then turned and left the room.

Traynor felt stunned. He looked down at Tom as if he expected him to wake up and explain Dr. Portland’s behavior. Traynor could understand how doctors might become emotionally involved in their patients’ conditions, but Portland seemed unhinged.

Traynor tried one last time to communicate with Tom. Recognizing the futility, he backed away from the bed and slipped out of the room. Warily he looked for Dr. Portland. When he didn’t see him, Traynor quickly walked to Beaton’s office. Caldwell and Kelley were already there.

“Do you all know Dr. Portland?” Traynor asked as he took a chair.

Everyone nodded. Kelley spoke: “He’s one of ours. He’s an orthopedic surgeon.”

“I just had a very peculiar and unnerving encounter with him,” Traynor said. “On my way here I popped in to see my client, Tom Baringer, who’s very sick. Dr. Portland was sitting in the corner of Tom’s darkened room. I didn’t even see him when I first went in. When he spoke, he acted strangely, even belligerently. I imagine he’s distraught over Tom’s condition, but he said something about not taking all the blame and that there was something wrong with the hospital.”

“I think he’s been under strain from overwork,” Kelley said. “We’re short at least one orthopedic surgeon. Unfortunately our recruiting efforts have been unsuccessful so far.”

“He looked ill to me,” Traynor said. “I advised him to see a doctor, but he only laughed.”

“I’ll have a talk with him,” Kelley promised. “Maybe he needs a little time off. We can always get a locum tenens for a few weeks.”

“Well, so much for that,” Traynor said, trying to compose himself more in keeping with his role as chairman of the board. “Let’s get our meeting underway.”

“Before we do that,” Kelley said, flashing one of his winning smiles, “there’s something I have to say. My superiors are very upset about the negative ruling on the CON for open-heart surgery.”

“We were disappointed about that as well,” Traynor said nervously. He didn’t like beginning on a negative note. “Unfortunately it’s out of our hands. Montpelier turned us down even though we thought we’d made a good case.”

“CMV had expected the open-heart program to be up and running by now,” Kelley said. “It was part of the contract.”

“It was part of the contract provided we got the CON,” Traynor corrected. “But we didn’t. So let’s look at what has been done. We’ve updated the MRI, built the neonatal ICU, and replaced the old cobalt-60 machine with a new state-of-the-art linear accelerator. I think we have been showing remarkably good faith, and we’ve been doing all this while the hospital has been losing money.”

“Whether the hospital loses money or not is not CMV’s concern,” Kelley said. “Especially since it’s probably due to minor management inefficiencies.”

“I think you are wrong,” Traynor said, swallowing his anger at Kelley’s insulting insinuation. He hated being put on the defensive, especially by this young, brazen bureaucrat. “I think CMV has to be concerned if we are losing money. If things get much worse we could be forced to close our doors. That would be bad for everyone. We have to work together. There’s no other choice.”

“If Bartlet Community Hospital goes under,” Kelley said, “CMV would take its business elsewhere.”

“That’s not so easy anymore,” Traynor said. “The two other hospitals in the area are no longer functioning as acute care facilities.”

“No problem,” Kelley said casually. “If need be, we would ferry our patients to the CMV hospital in Rutland.”

Traynor’s heart skipped a beat. The possibility of CMV ferrying its patients had never occurred to him. He’d hoped that the lack of nearby hospitals would give him some bargaining power. Apparently it didn’t.

“I don’t mean to imply that I’m not willing to work together with you people,” Kelley said. “This should be a dynamic relationship. After all, we have the same goal: the health of the community.” He smiled again as if to show off his perfectly straight white teeth.

“The problem is the current capitation rate is too low,” Traynor said bluntly. “Hospitalization from CMV is running more than ten percent above projections. We can’t support such an overrun for long. We need to renegotiate the capitation rate. It’s that simple.”

“The capitation rate doesn’t get renegotiated until the contract term is over,” Kelley said amicably. “What do you take us for? You offered the present rate in a competitive bidding process. And you signed the contract. So it stands. What I can do is start negotiations on a capitation rate for ER services, which was left out of the initial agreement.”

“Capitating the ER is not something we can do at the moment,” Traynor said, feeling perspiration run down the insides of his arms. “We have to stem our red ink first.”

“Which is the reason for our meeting this afternoon,” Beaton said, speaking up for the first time. She then presented the final version of the proposed bonus program for CMV physicians.

“Each gatekeeper CMV physician will be allocated a bonus payment provided his number of monthly hospital days per assigned subscriber stays at a given level. As the level goes down, the payment goes up and vice versa.”

Kelley laughed. “Sounds like clever bribery to me. As sensitive as doctors are to economic incentives, it certainly should reduce hospitalization and surgery.”

“It’s essentially the same plan CMV has in effect at the CMV hospital in Rutland.”

“If it works there then it should work here,” Kelley said. “I have no trouble with it, provided it doesn’t cost CMV anything.”

“It will be totally funded by the hospital,” Beaton said.

“I’ll present it to my superiors,” Kelley said. “Is that it for this meeting?”

“That’s it,” Beaton said.

Kelley got to his feet.

“We’d appreciate all the speed you can muster,” Traynor said. “I’m afraid we’re looking at a lot of red ink on our balance sheet.”

“I’ll do it today,” Kelley promised. “I’ll try to have a definitive answer by tomorrow.” With that, he shook hands with everyone and left the room.

“I’d say that went as well as could be expected,” Beaton said once he was gone.

“I’m encouraged,” Caldwell said.

“I didn’t appreciate his impudent suggestion of incompetent management,” Traynor said. “I don’t like his cocky attitude. It’s unfortunate we have to deal with him.”

“What I didn’t like hearing was the threat to ferry patients to Rutland,” Beaton said. “That worries me. It means our bargaining position is even weaker than I thought.”

“Something just occurred to me,” Traynor said. “Here we’ve had this high-level meeting that could possibly determine the fate of the hospital and there were no doctors present.”

“It’s a sign of the times,” Beaton said. “The burden of dealing with the health-care crisis has fallen on us administrators.”

“I think it’s the medical world’s equivalent of the expression, ‘War is too important to leave up to the generals,’  ” Traynor said.

They all laughed. It was a good break from the tension of the meeting.

“What about Dr. Portland?” Caldwell asked. “Should I do anything?”

“I don’t think there’s anything to be done,” Beaton said. “I haven’t heard anything but good things about his surgical abilities. He certainly hasn’t violated any rules or regulations. I think we’ll have to wait and see what CMV does.”

“He didn’t look good to me,” Traynor reiterated. “I’m no psychiatrist and I don’t know what someone looks like when they’re about to have a nervous breakdown, but if I had to guess, I’d guess they’d look the way he does.”

The buzz of the intercom surprised them all, especially Beaton who’d left explicit instructions there were to be no interruptions.

“Some bad news,” she said once she hung up. “Tom Baringer has died.”

The three fell silent. Traynor was the first to speak: “Nothing like a death to remind us that for all the red and black ink, a hospital really is a very different kind of business.”

“It’s true,” Beaton said. “The burden of the work is that the whole town, even the whole region, becomes like an extended family. And as in any large family, someone is always dying.”

“What is our death rate here at Bartlet Community Hospital?” Traynor asked. “It’s never occurred to me to ask.”

“We’re just about in the middle of the road,” Beaton said. “Plus or minus a percentage point. In fact, our rate is better than most of the inner-city teaching hospitals.”

“That’s a relief,” Traynor said. “For a moment I was afraid there was something else I had to worry about.”

“Enough of this morbid talk,” Caldwell said. “I have some good news. The husband-and-wife team that we and CMV have been recruiting so actively has decided to come to Bartlet. So we’ll be getting a superbly trained pathologist.”

“I’m glad to hear it,” Traynor said. “That brings pathology up to speed.”

“They’ve even purchased the old Hodges house,” Caldwell added.

“No kidding!” Traynor said. “I like that. There’s something wonderfully ironic about it.”

Charles Kelley slipped into his Ferrari coupe, started the engine, and gave it some gas. It responded like the engineering marvel it was, pressing him against the seat as he accelerated out of the hospital parking lot. He loved to drive the car, especially in the mountains. The way it hugged the road and cornered was a true delight.

After the meeting with the Bartlet Hospital people Kelley had phoned Duncan Mitchell directly, thinking it was a good opportunity to make his presence known to the man at the pinnacle of power. Duncan Mitchell was the CEO of CMV, as well as of several other HMOs and hospital management companies in the South. Conveniently the home office was in Vermont where Mr. Mitchell had a farm.

Kelley had not known what to expect and had been nervous when he called, but the CEO turned out to be gracious. Although Kelley had caught the man preparing to go to Washington, he had generously agreed to meet with Kelley outside the Burlington Airport general aviation building.

With CMV’s Learjet in its final stages of fueling, Mitchell invited Kelley into the back of his limousine. He offered Kelley a drink from the limo’s bar. Kelley politely refused.

Duncan Mitchell was an impressive man. He wasn’t as tall as Kelley, yet he emanated a sense of power. He was meticulously dressed in a conservative business suit with a silk tie and gold cufflinks. His Italian loafers were dark brown crocodile.

Kelley introduced himself and gave a brief history of his association with CMV, mentioning that he was the regional director for the area centered around Bartlet Community Hospital, just in case Mitchell didn’t know. But Mitchell seemed acquainted with Kelley’s position.

“We eventually want to buy that facility,” he said.

“I assumed as much,” Kelley said. “And that’s why I wanted to come to talk with you directly.”

Mr. Mitchell slipped a gold cigarette case from his vest pocket and took out a cigarette. He tapped it thoughtfully against the case’s flat front surface. “There’s a lot of profit to be squeezed out of these rural hospitals,” Mitchell said. “But it takes careful management.”

“I couldn’t agree more,” Kelley said.

“What is it you wanted to talk about?” Mr. Mitchell asked.

“Two issues,” Kelley said. “The first involves a bonus program the hospital wants to initiate similar to our own with our hospitals. They want to cut down on hospitalization.”

“And what’s the other?” Mitchell asked. He blew smoke up toward the ceiling of the car.

“One of our CMV physicians has begun acting bizarrely in response to post-operative complications in his patients,” Kelley said. “He’s saying things like he’s not to blame and there’s something wrong with the hospital.”

“Does he have a psychiatric history?” Mr. Mitchell asked.

“Not that we can determine,” Kelley said.

“Regarding the first issue, let them have their bonus program. At this point it doesn’t matter about their balance sheet.”

“What about the doctor?” Kelley asked.

“Obviously you’ll have to do something,” Mitchell said. “We can’t let that type of behavior go on.”

“Any suggestions?” Kelley asked.

“Do what you need to do,” Mitchell said. “I’ll leave the details up to you. Part of the skill of running a large organization like ours is knowing when to delegate responsibility. This is one of those times.”

“Thank you, Mr. Mitchell,” Kelley said. He was pleased. It was obvious to him that he was being given a vote of confidence.

Elated, Kelley climbed out of the limousine and got back into his Ferrari. As he was pulling out of the airport he caught a glimpse of Mitchell walking from his car to the CMV jet.

“Someday,” Kelley vowed, “it’ll be me using that plane.”

Both the internal medicine department and the pathology department had small, informal ceremonies for that year’s group of graduates, marking the end of their residencies. After collecting their diplomas, David and Angela passed up the parties scheduled for that afternoon and hurried home. This was the day they would leave Boston for their new home and careers in Bartlet, Vermont.

“Are you excited?” David asked Nikki.

“I’m excited to see Rusty,” Nikki announced.

They’d rented a U-Haul truck to help make the move. It took quite a few trips up and down the stairs to get their possessions in the two vehicles. Once they were finally packed, Angela got in their station wagon and David got in the U-Haul. For the first half of the trip, Nikki elected to ride with her dad.

David used the time to talk with Nikki about starting at a new school and ask her if she’d miss her friends.

“Some of them I’ll miss,” Nikki said, “but others I won’t. Anyway, I think I’ll cope.”

David smiled, promising himself that he would remember to tell Angela about Nikki’s precocious comment.

Just south of the New Hampshire border, they stopped for lunch. Eager to arrive at their new home, they ate quickly.

“I feel wonderful about leaving the frantic, crime-filled city behind,” Angela said as they left the restaurant and approached their vehicles. “At this point I don’t care if I ever go back.”

“I don’t know,” David joked. “I’m going to miss hearing sirens, gunshots, breaking glass, and cries for help. Country life is going to be so boring.”

Both Nikki and Angela pummeled him in mock anger.

For the rest of the trip Nikki joined Angela in the station wagon.

As they drove north the weather improved. In Boston it had been hot, muggy, and hazy. By the time they crossed into Vermont it was still warm but clear and much less humid.

Bartlet appeared serene in the early summer heat. Flower-filled window boxes adorned almost every sill. Slowing down, the Wilsons’ two-vehicle caravan crept through the lazy town. Few people were on the streets. It was as if everyone were napping.

“Can we stop and get Rusty?” Nikki asked as they neared Staley’s Hardware Store.

“Let’s get a bit settled first,” Angela said. “We’ll have to build something to keep him in until he gets housebroken.”

David and Angela pulled into their driveway and parked side by side. Now that the house was officially theirs they felt even more awed than they had on their initial visit.

David climbed out of the truck, his eyes glued to the house. “The place is lovely,” he said. “But it looks like it needs more attention than I realized.”

Angela walked over to David and followed his line of sight. Some of the decorative dentil work had fallen from the cornice. “I’m not worried,” she said. “That’s why I married someone who is handy around the house.”

David laughed. “I can see it’ll take some effort to make a believer out of you.”

“I’ll try to keep an open mind,” she teased.

With a key they had been sent in the mail, they opened the front door and stepped inside. It looked very different without furniture. When they’d seen it before it had been filled with the Hodgeses’ belongings.

“It has a dance hail feel,” David said.

“There’s even an echo,” Nikki said. She yelled “Hello” and the word reverberated.

“That’s when you know you’ve arrived at your proper station in life,” David said, affecting an English accent. “When your house has an echo.”

The Wilsons slowly passed through the foyer. Now that there were no rugs, their heels clicked on the wide wooden flooring. They had forgotten their new home’s enormity, especially in contrast to their Boston apartment. Aside from a few pieces of furniture they’d agreed Clara would leave behind—a stool, a kitchen table—the place was bare.

In the center hall just before the grand staircase an imposing chandelier hung. There was a library and dining room to the left and a huge living room to the right. A central hall led to a spacious country kitchen which stretched across the back of the house. Beyond the kitchen was the two-story clapboard addition that connected the house to the barn. It had a mud room, several storerooms, and a back staircase leading up to the second level.

Returning to the grand staircase, the Wilsons climbed up to the second story. There were two bedrooms with connecting baths on each side and a master suite over the kitchen area.

Opening a door off the central hallway next to the master suite, they climbed a narrow staircase up to the third level where there were four unheated rooms.

“Plenty of storage,” David quipped.

“Which room will be my bedroom?” Nikki asked.

“Whatever room you want,” Angela said.

“I want the room facing the frog pond,” she said.

They went down to the second level and walked into the room Nikki wanted. They discussed where her furniture would go, including the desk she did not yet own.

“Okay, you guys,” Angela commanded. “Enough procrastination. Time to unload.”

David gave her a military salute.

Returning to the vehicles, they began to bring their belongings into the house and put them into the appropriate rooms. The couch, the bedding, and the heavy boxes of books made it quite a struggle. When they were finished David and Angela stood beneath the archway leading into the living room.

“It would be funny if it wasn’t so pathetic,” Angela said. The rug that had been almost wall to wall in their apartment seemed little better than a doormat in the middle of the expansive room. Their threadbare couch, two armchairs, and coffee table looked like they had been rescued from a garage sale.

“Understated elegance,” David said. “Minimalist decor. If it were in Architectural Digest, everyone would be trying to imitate it.”

“What about Rusty?” Nikki asked.

“Let’s go get him,” David said. “You’ve been a good sport and a big help. You want to come, Angela?”

“No thanks,” Angela said. “I’ll stay and get more organized, especially in the kitchen.”

“I assumed we’d eat down at the inn tonight,” David said.

“No, I want to eat here in our new home,” Angela answered.

While David and Nikki went to town, Angela unpacked a few of the boxes in the kitchen including their pots, pans, dishes, and flatware. She also figured out how to work the stove and got the refrigerator running.

Nikki returned carrying the adorable puppy with its wrinkled face and floppy ears. She had the dog pressed against her chest. He’d grown considerably since they’d seen him last. His feet were the size of Nikki’s fists.

“He’s going to be a big dog,” David said.

While Nikki and David fashioned a pen for Rusty in the mud room, Angela made dinner for Nikki. Nikki wasn’t happy about eating before her parents, but she was too tired to complain. After she’d eaten and done some postural drainage, she and Rusty, both exhausted, were put to bed.

“Now I have a little surprise for you,” Angela said as she and David descended from Nikki’s room. She took him by the hand and led him into the kitchen. Opening the refrigerator, she pulled out a bottle of Chardonnay.

“Wow,” David exclaimed, inspecting the label. “This isn’t our usual cheap stuff.”

“Hardly,” Angela said. Reaching back into the refrigerator, she took out a dish covered with a paper towel. Lifting the towel she exposed two thick veal chops.

“I have the feeling we’re in for a feast,” David said.

“You’d better believe it,” Angela said. “Salad, artichokes, wild rice, and veal chops. Plus the best Chardonnay I could buy.”

David cooked the meat on an outdoor barbecue built into the side of the terrace off the library. By the time he came in Angela had the rest of the food on the table in the dining room.

Night had descended softly, filling the house with shadow. In the darkness the glow from the two candles that formed the centerpiece on the table only illuminated the immediate area. The disarray of the rest of the house was hidden.

They sat at opposite ends of the table. They didn’t speak. Instead they merely gazed at each other as they ate. Both of them were moved by the romantic atmosphere, realizing that romance had been missing from their lives over the last years; the demands of their respective residencies and Nikki’s ongoing health problems had taken precedence.

Long after they’d finished eating they continued to sit and stare at each other while a symphony of sounds of a Vermont summer night drifted in through the open windows. The candle flames flickered sensuously as the clean, cool air wafted across the room and caressed their faces. It was a magical moment they both wanted to savor.

Mutual desire drove them from the dining room into the dark living room. They fell onto the couch, their lips meeting as they enveloped each other in a warm embrace. They removed their clothing, each eagerly aiding the other. With a chorus of crickets in the background, they made love in their new home.

Morning brought mass confusion. With the dog barking to be fed and Nikki whining that she couldn’t find her favorite jeans, Angela felt her patience was at an end. David was no help. He couldn’t find the list he’d made of what was in each of the dozens of boxes left to be unpacked.

“All right, that’s enough,” Angela shouted. “I don’t want to hear any more whining or barking.”

For the moment, even Rusty quieted down.

“Calm down, dear,” David said. “Getting upset isn’t going to solve anything.”

“And don’t you tell me not to get upset,” Angela cried.

“All right,” David said calmly. “I’ll go get the babysitter.”

“I’m not a baby,” Nikki whined.

“Oh, save me,” Angela said with her face raised to the ceiling.

While David was off fetching Alice Doherty, Dorothy Weymouth’s older sister, Angela was able to regain control of herself. She realized that it had been a mistake to tell their respective employers that they would be willing to start on July first. They should have given themselves a few days to get settled.

Alice turned out to be a godsend. She looked quite grandmotherly with her warm caring face, a twinkle in her eye, and snow-white hair. She had an engaging manner and surprising energy for a woman of seventy-nine. She also had the compassion and patience a chronically ill, willful child like Nikki required. Best of all, she loved Rusty which immediately endeared her to Nikki.

The first thing Angela did was show her how to do Nikki’s respiratory therapy. It was important for Alice to learn the procedure, and she proved to be a quick study.

“Don’t you two worry about a thing,” Alice called to David and Angela as they went out the back door. Nikki was holding Rusty, and she waved the dog’s paw to say goodbye.

“I want to ride my bike,” David announced once he and Angela got outside.

“Are you serious?” Angela asked.

“Absolutely,” David said.

“Suit yourself,” Angela said as she climbed into the Volvo and started the engine. She waved once to David as she descended the long drive and turned right toward town.

Although Angela was confident about her professional capabilities, she still felt nervous about starting her first real job.

Mustering her courage and reminding herself that first-day jitters were natural, she reported to Michael Caldwell’s office. Caldwell immediately took her to meet Helen Beaton, the president of the hospital. Beaton happened to be in conference with Dr. Delbert Cantor, the chief of the professional staff, but she interrupted the meeting to welcome Angela. She invited Angela into her office and introduced her to Dr. Cantor as well.

While shaking her hand, Dr. Cantor unabashedly looked Angela up and down. She had chosen to wear one of her best silk dresses for her first day. “My, my,” he said. “You certainly don’t look like the few girls in my medical school class. They were all dogs.” He laughed heartily.

Angela smiled. She felt like saying her class was just the opposite—the few men were all dogs—but she held her tongue. She found Dr. Cantor instantly offensive. He was clearly part of the old-school minority that still wasn’t comfortable with women in the medical profession.

“We are so glad to have you join the Bartlet Community Hospital family,” Beaton said as she escorted Angela to the door. “I’m confident you’ll find the experience both challenging and rewarding.”

Leaving the administration area, Caldwell took Angela to the clinical lab. As soon as Dr. Wadley saw her he leaped up from his desk and even gave her a hug as if they were old friends.

“Welcome to the team,” Dr. Wadley said with a warm smile, his hands still gripping Angela’s arms. “I’ve been anticipating this day for weeks.”

“I’ll be off,” Caldwell said to Angela. “I can see you’re in good hands here.”

“Great job recruiting this talented pathologist,” Wadley told Caldwell. “You’re to be commended.”

Caldwell beamed.

“A good man,” Wadley said, watching him leave.

Angela nodded, but she was thinking about Wadley. Although she was again aware of how much the man reminded her of her father, now she was equally aware of their differences. Wadley’s enthusiastic fervor was a welcome change from her father’s aloof reserve. Angela was even charmed by Wadley’s demonstrative welcome. It was reassuring to feel so wanted on her first day.

“First things first,” Wadley said, rubbing his hands together. His green eyes shone with child-like excitement. “Let me show you your office.”

He pushed open a connecting door from his own office into another that looked as though it had been recently decorated. The room was entirely white: the walls, the desk, everything.

“Like it?” Wadley asked.

“It’s wonderful,” Angela said.

Wadley pointed back toward the connecting door. “That will always be open,” he said. “Literally and figuratively.”

“Wonderful,” Angela repeated.

“Now let’s tour the lab again,” Wadley said. “I know you saw it once, but I want to introduce you to the staff.” He took a long, crisp, professional white coat from a hook and put it on.

For the next fifteen minutes Angela met more people than she could hope to remember. After circling the lab, they stopped at a windowless office next to the microbiology section. The office belonged to Dr. Paul Darnell, Angela’s fellow pathologist.

In contrast to Wadley, Darnell was a short man whose clothing was rumpled and whose white coat was spotted haphazardly with stains used in preparing pathological slides. He seemed agreeable but plain and retiring, almost the antithesis of the affable and flamboyant Wadley.

After the tour was over, Wadley escorted Angela back to his office where he explained her duties and responsibilities. “I’m going to try to make you one of the best pathologists in the country,” he said with a true mentor’s enthusiasm.

David had enjoyed his three-and-a-half-mile bicycle ride immensely. The clean, crisp morning air had been delicious, and the bird life even more abundant than he’d imagined. He’d spotted several hummingbirds along the way. To top it off, he caught a fleeting glimpse of several deer across a dew-laden field just after crossing the Roaring River.

Arriving at the professional building, David discovered he was too early. Charles Kelley didn’t show up until almost nine.

“My word, you are eager!” Kelley said when he spotted David perusing magazines in the CMV waiting area. “Come on in.”

David followed Kelley into his office where Kelley had him fill out a few routine forms. “You’re joining a crackerjack team,” Kelley said while David worked. “You’re going to love it here: great facilities, superbly trained colleagues. What else could you want?”

“I can’t think of anything,” David admitted.

When the paperwork was completed and after Kelley explained some of the ground rules, he accompanied David to his new office. As Kelley opened the office suite door and entered, David stopped to admire his nameplate that had already been installed in the slot on the outside of the door. He was surprised to see the name “Dr. Kevin Yansen” above his.

“Is this the same suite?” David asked in a lowered voice after catching up with Kelley. There were six patients in the waiting room.

“Same one,” Kelley said. He knocked on the mirror, and after it had slid open, he introduced David to the receptionist he would be sharing with Dr. Yansen.

“Glad to meet you,” Anne Withington said in a heavy South Boston accent, She cracked her gum, and David winced.

“Come in to see your private office,” Kelley said. Over his shoulder he told Anne to send Dr. Yansen in to meet Dr. Wilson when he appeared between patients.

David was confused. He followed Kelley into what had been Dr. Portland’s office. The walls had been repainted a light gray, and new gray-green carpet had been installed.

“What do you think?” Kelley asked, beaming.

“I think it’s fine,” David said. “Where did Dr. Portland go?”

Before Kelley could respond, Dr. Yansen appeared at the doorway and whisked into the room with his hand outstretched. Ignoring Kelley, he introduced himself to David, telling David to call him Kevin. He then slapped David on the back. “Welcome! Good to have you join the squad,” he said. “You play basketball or tennis?”

“A little of both,” David said, “but none recently.”

“We’ll have to get you back in the swing,” Kevin said.

“Are you an orthopedist?” David asked as he looked at his new suitemate. He was a squarely built man with an aggressive-looking face. A mildly hooked nose supported thick glasses. He was four inches shorter than David, and standing next to Kelley, he appeared diminutive.

“Orthopedist?” Kevin laughed scornfully. “Hardly! I’m at the opposite end of the operative spectrum. I’m an ophthalmologist.”

“Where’s Dr. Portland?” David asked again.

Kevin looked at Kelley. “You haven’t told him yet?”

“Haven’t had a chance,” Kelley said, spreading his hands, palms up. “He just got here.”

“I’m afraid Dr. Portland is no longer with us,” Kevin said.

“He’s left the group?” David asked.

“In a manner of speaking,” Kevin said with a wry smile.

“I’m afraid Dr. Portland committed suicide back in May,” Kelley said.

“Right here in this room,” Kevin said. “Sitting there at that desk.” He pointed at the desk. Then Kevin formed his hand into a pistol with his index finger serving as the barrel, and pointed it at his forehead. “Bam!” he said. “Shot himself right through the forehead out the back. That’s why the walls had to be painted and the carpet changed.”

David’s mouth went bone-dry. He gazed at the blank wall behind the desk and tried not to imagine what it had looked like after the incident. “How awful,” David said. “Was he married?”

“Unfortunately,” Dr. Yansen said with a nod. “Wife and two young boys. A real tragedy. I knew something was wrong. All of a sudden he stopped playing basketball on Saturday mornings.”

“He didn’t look good the last time I saw him,” David said. “Was he ill? He’d looked as if he’d lost a lot of weight.”

“Depressed,” Kelley said.

David sighed. “Boy, you never know!”

“Let’s move on to a happier subject,” Kelley said after he’d cleared his throat. “I took you at your word, Dr. Wilson. We’ve scheduled patients for you this morning. Are you up to it?”

“Absolutely,” David said.

Kevin wished David well and headed back to one of the examining rooms. Kelley introduced David to Susan Beardslee, the nurse he’d be working with. Susan was an attractive woman in her mid-twenties, with dark hair cut short to frame her face. What David immediately liked about her was her lively, enthusiastic personality.

“Your first patient is already in the examining room,” Susan said cheerfully. She handed him the chart. “When you need me, just buzz. I’ll be getting the next patient ready.” She disappeared into the second examining room.

“I think this is where I leave,” Kelley said. “Good luck, David. If there are any questions or problems, just holler.”

David flipped open the cover of the chart and read the name: Marjorie Kleber, aged thirty-nine. The complaint was chest pain. He was about to knock on the examining room door when he read the diagnostic summary: breast cancer treated with surgery, chemotherapy, and radiation. The cancer had been diagnosed four years previously at age thirty-five. At the time of the discovery, the cancer had spread to the lymph nodes.

David quickly scanned the rest of the chart. He was mildly unnerved and needed a moment to prepare himself. A patient with breast cancer that had metastasized, or spread from the breast to other areas of the body, was a serious case with which to begin his medical career. Happily Marjorie had been doing well.

David knocked on the door and entered. Marjorie Kleber was sitting patiently on the examining table dressed in an examining gown. She looked up at David with large, sad, intelligent eyes. Her smile was the kind of smile that warmed his heart.

David introduced himself and was about to ask about her current complaint when she reached out and took one of his hands in hers. She squeezed it and held it to her chest at the base of her neck.

“Thank you for coming to Bartlet,” she said. “You’ll never know how much I have prayed for someone like you to come here. I’m truly overjoyed.”

“I’m happy to be here,” David stammered.

“Prior to your corning, I’ve had to wait up to four weeks to be seen,” she said as she finally released David’s hand. “That’s the way it’s been since the school’s health-care coverage was switched to CMV. And every time it’s been a different doctor. Now I’ve been told that you will be my doctor. It’s so reassuring.”

“I’m honored to be your doctor,” David said.

“Waiting four weeks to be seen was so scary,” Marjorie continued. “Last winter I had the flu so bad that I thought it was pneumonia. Luckily, by the time I was seen I was over the worst of it.”

“Maybe you should have gone to the emergency room,” David suggested.

“I wish I could have,” Marjorie said. “But we’re not allowed. I did go once the winter before last, but CMV refused to pay because it turned out to be the flu. Unless my problem is life-threatening, I have to come here to the office. I can’t go to the emergency room without prior approval from a CMV physician. If I do, they won’t pay.”

“But that’s absurd,” David said. “How can you know in advance if your problem is life-threatening?”

Marjorie shrugged. “That’s the same question I asked, but they didn’t have an answer. They just reiterated the rule. Anyway, I’m glad you’re here. If I have a problem I’ll call you.”

“Please do,” David said. “Now let’s start talking about your health. Who is following you in regard to your cancer?”

“You are,” Marjorie said.

“You don’t have an oncologist?” David asked.

“CMV doesn’t have an oncologist,” Marjorie said. “I’m to see you routinely and Dr. Mieslich, the oncologist, when you think it is necessary. Dr. Mieslich is not a CMV physician. I can’t see him unless you order it.”

David nodded, recognizing that there were realities about his new practice that would take time to learn. He also knew he’d have to spend considerable time going over Marjorie’s chart in detail.

For the next fifteen minutes, David applied himself to the process of “working up” Marjorie’s chest pain. While listening to her chest and in between her deep breathing, he asked her what she did at the school.

“I’m a teacher,” Marjorie said.

“What grade?” he asked. He took his stethoscope from his ears and began preparations to run an EKG.

“Third grade,” she said proudly. “I taught second grade for a number of years, but I much prefer third. The children are really blossoming then.”

“My daughter is to start the third grade in the fall,” David said.

“How wonderful,” Marjorie said. “Then she’ll be in my class.”

“Do you have a family?” David asked.

“My word, yes!” Marjorie said. “My husband, Lloyd, works at the computer software company. He’s a programmer. We have two children: a boy in high school and a girl in the sixth grade.”

Half an hour later David felt confident enough to reassure Marjorie that her chest pain was not at all serious and that it had nothing to do with either her heart or her cancer, Marjorie’s two chief concerns. She thanked him profusely once again for coming to Bartlet before he stepped out of the room.

David ducked into his private office with a sense of exuberance. If all his patients were as warm and appreciative as Marjorie, he could count on a rewarding career in Bartlet. He put her chart on his desk for further study.

Taking the file from its holder on the second examining room door, David perused his next patient’s chart. The diagnostic summary read: leukemia treated with massive chemotherapy. David inwardly groaned; it was another difficult case that would require more “homework.” The patient’s name was John Tarlow. He was a forty-eight-year-old man who’d been under treatment for three and a half years.

Stepping into the room, David introduced himself. John Tarlow was a handsome, friendly man whose face reflected intelligence and warmth equal to Marjorie’s. Despite his complicated history, John’s complaint of insomnia was both easier and quicker to deal with than Marjorie’s chest pain. After a short conversation it was clear to David that the problem was an understandable psychological reaction to a death in the family. David gave him a prescription for some sleeping medication that he was certain would help John get back to his usual routine.

After he was through with John, David added his chart to Marjorie’s for further review. Then he searched for Susan. He found her in the tiny lab used for simple, routine tests.

“Are there a lot of oncology patients in the practice?” David asked hesitantly.

David very much admired the sort of people who chose to go into oncology. He knew himself well enough to know that he was not suited for the specialty. So it was with some trepidation that he discovered his first two CMV patients were both dealing with cancer.

Susan assured him that there were only a few such patients. David wanted to believe her. When he went back to get the chart out of the box on examining room one, he felt reassured. It wasn’t an oncological problem; the case concerned diabetes.

David’s morning passed quickly and happily. The patients had been a delight. They’d all been affable, attentive to what David had to say, and, in contrast to the non-compliant patients he’d dealt with during his residency, eager to follow his recommendations. All of them had also expressed appreciation for David’s arrival, not as fervently as Marjorie, but enough to make David feel good about his reception.

For lunch, David met Angela at the coffee shop run by the volunteers. Over sandwiches, they discussed their morning.

“Dr. Wadley is terrific,” Angela said. “He’s very helpful and interested in teaching. The more I see him, the less he reminds me of my father. He’s far more demonstrative than my father ever would be—far more enthusiastic and affectionate. He even gave me a hug when I arrived this morning. My father would die before he’d do that.”

David told Angela about the patients he’d seen. She was particularly touched to hear about Marjorie Kleber’s reaction to David’s arrival.

“She’s a teacher,” David added. “In fact she teaches the third grade so she’ll be Nikki’s teacher.”

“What a coincidence,” Angela said. “What’s she like?”

“She seems warm, giving, and intelligent,” David said. “I’d guess she’s a marvelous teacher. The problem is she’s had metastatic breast cancer.”

“Oh, dear,” Angela said.

“But she’s been doing fine,” David said. “I don’t think she’s had any recurrence yet, but I haven’t gone over her chart in detail.”

“It’s a bad disease,” Angela said, thinking how many times she’d worried about it herself.

“The only complaint I have so far about the practice is that I’ve seen too many oncology patients,” David said.

“I know that’s not your cup of tea,” Angela said.

“The nurse says it was just a coincidence that I started with two in a row,” David said. “I’ll have to keep my fingers crossed.”

“Now don’t get depressed,” Angela said. “I’m sure your nurse was right.” Angela remembered all too well David’s response to the deaths of several oncology patients when he’d been a junior resident.

“Talk about depression,” David said. He leaned closer and whispered. “Did you hear about Dr. Portland?”

Angela shook her head.

“He committed suicide,” David said. “He shot himself in the office that I’m now using.”

“That’s terrible,” Angela said. “Do you have to stay there? Maybe you can move to a different suite.”

“Don’t be ridiculous,” David said. “What am I going to say to Kelley? I’m superstitious about death and suicide? I can’t do that. Besides, they repainted the walls and recarpeted the floor.” David shrugged. “It’ll be okay.”

“Why did he do it?” Angela asked.

“Depression,” David said.

“I knew it,” Angela said. “I knew he was depressed. I even said it. Remember?”

“I didn’t say he wasn’t depressed,” David said. “I said he looked ill. Anyway, he must have killed himself soon after we met him because Charles Kelley said he’d done it in May.”

“The poor man,” Angela said. “Did he have a family?”

“A wife and two young boys.”

Angela shook her head. Suicide among doctors was an issue of which she was well aware. One of her resident colleagues had killed herself.

“On a lighter note,” David said, “Charles Kelley told me that there’s a bonus plan to reward me for keeping hospitalization at a minimum. The less I hospitalize the more I get paid. I can even win a trip to the Bahamas. Can you believe it?”

“I’ve heard of that kind of incentive plan,” Angela said. “It’s a ploy health maintenance organizations use to reduce costs.”

David shook his head in disbelief. “Some of the realities of this ‘managed care’ and ‘managed competition’ stuff are really mind-boggling. I personally find it insulting.”

“Well, on a lighter note of my own, Dr. Wadley’s invited us to his home for dinner tonight. I told him I’d have to ask you. What do you think?”

“Do you want to go?” David asked.

“I know we have a lot to do at home, but I think we should go. He’s being so thoughtful and generous. I don’t want to appear ungrateful.”

“What about Nikki?” David asked.

“That’s another piece of good news,” Angela said. “I found out from one of the lab technicians that Barton Sherwood has a daughter in high school who does a lot of sitting. They are our closest neighbors. I called and she’s eager to come over.”

“Think Nikki will mind?” David asked.

“I already asked her,” Angela said. “She said she didn’t care and that she’s looking forward to meeting Karen Sherwood. She’s one of the cheerleaders.”

“Then let’s go,” David said.

Just before seven Karen Sherwood arrived. David let her in. He wouldn’t have guessed she was a cheerleader. She was a thin, quiet young woman who unfortunately looked a lot like her father. Yet she was pleasant and intuitive. When she was introduced to Nikki she was smart enough to say she loved dogs, especially puppies.

While David drove Angela finished putting on her makeup. David could tell she was tense, and he tried to reassure her that everything would be fine and that she looked terrific. When they pulled up to the Wadley home, both were impressed. The house wasn’t as grand as theirs, but it was in far better condition and the grounds were immaculate.

“Welcome,” Wadley said as he threw open his front door to greet the Wilsons.

The inside of the house was even more impressive than the outside. Every detail had been attended to. Antique furniture stood on thick oriental carpets. Pastoral nineteenth-century paintings adorned the walls.

Gertrude Wadley and her courtly husband were significantly different people, lending credence to the saying “opposites attract.” She was a retiring, mousy woman who had little to say. It was as if she’d been submerged by her husband’s personality.

Their teenage daughter, Cassandra, seemed more like her mother initially, but as the evening progressed, she became more like her outgoing father.

But it was Wadley who dominated the evening. He pontificated on a number of subjects. And he clearly doted on Angela. At one point he looked skyward and thanked the fates that he had been rewarded with such a competent team now that Angela had arrived.

“One thing is for sure,” David said as they drove home, “Dr. Wadley is thrilled with you. Of course, I can’t blame him.”

Angela snuggled up to her husband.

Arriving home, David accompanied Karen across the fields to her home, even though she insisted she’d be fine. When David got back, Angela met him at the door in lingerie she hadn’t worn since their honeymoon.

“It looks better now when I’m not pregnant,” Angela said. “Don’t you agree?”

“It looked great then and it looks great now.”

Stealing into the semi-dark living room, they lowered themselves onto the couch. Slowly and tenderly they made love again. Without the frenzy of the previous evening, it was even more satisfying and fulfilling.

Once they were through, they held each other and listened to the symphony of chirping crickets and croaking frogs.

“We’ve made love more here in the last two days than in the previous two months in Boston,” Angela said with a sigh.

“We’ve been under a lot of stress.”

“It makes me wonder about another child,” Angela said.

David moved so that he could make out Angela’s profile in the darkness. “Really?” he asked.

“With a house this size, we could have a litter,” Angela said with a little laugh.

“We’d want to know if the child had cystic fibrosis. I suppose we could always rely on amniocentesis.”

“I suppose,” Angela said without enthusiasm. “But what would we do if it were positive?”

“I don’t know,” David said. “It’s scary. It’s hard to know what the right thing to do is.”

“Well, like Scarlett O’Hara said, let’s think about it tomorrow.”

Days melted into weeks and weeks into months as summer advanced. The sweet white corn grew chest-high across the road from the Wilsons’ house and could be heard rustling in the evening breeze from the front porch. Plump tomatoes ripened to a deep red in the garden by the terrace. Crab apples the size of golf balls began to drop from the tree next to the barn. Cicadas buzzed incessantly in the midmorning August heat.

David and Angela’s work continued to be stimulating and rewarding as they settled into their jobs. Each day brought some new experience that they enthusiastically shared with each other as they lingered over quiet suppers.

Rusty’s appetite remained undiminished and a source of wonder as he grew quickly and with great exuberance, catching up to the size of his feet. Yet despite his growth he maintained the same adorable quality he’d had as a tiny puppy. Everyone found it impossible to pass him without offering a pat on the head or a scratch behind a golden ear.

Nikki flourished in the new environment. Her respiratory status remained normal and her lungs stayed clear. She also made new friends. She was closest to Caroline Helmsford by far; Caroline was a petite child a year older than Nikki who also suffered from cystic fibrosis. Having had so many unique experiences in common, the girls formed a particularly strong bond.

They had met quite by accident. Although the Wilsons had been told about Caroline on their first visit to Bartlet, they’d made no attempt to contact her. The two girls had bumped into each other in the local grocery’ store which Caroline’s parents owned and ran.

Nikki also befriended the Yansen boy, Arni, who happened to be exactly Nikki’s age. Their birthdays were only a week apart. Arni was like his father: short, squarely built, and aggressive. He and Nikki hit it off and spent hours in and out of the barn, never at a loss for things to do.

As much as they loved their work, the Wilsons delighted in their weekends. Saturday mornings David rose with the sun to make hospital rounds, then played three-on-three basketball in the high school gym with a group of physicians.

Saturday and Sunday afternoons David and Angela devoted to work on the house. While Angela worked on the interior, busying herself with curtains and stripping old furniture, David tackled outdoor projects like fixing the porch or replacing the drainpipes. David proved even less handy than Angela had feared. He was forever running off to Staley’s Hardware Store for more advice. Fortunately, Mr. Staley took pity on David and gave him many lectures on fixing broken screens, leaky faucets, and burned-out electrical switches.

On Saturday, the twenty-first of August, David got up early as usual, made himself coffee, and left for the hospital. Rounds went quickly since he only had to see one patient, John Tarlow, the leukemia victim. Like David’s other oncology patients, John had to be hospitalized frequently for a variety of problems. This latest hospitalization resulted from an abscess on his neck. Fortunately, he was doing fine. David anticipated discharging him in the next few days.

After completing his rounds, David biked over to the high school for basketball. Entering the gym he discovered that there were more people than usual waiting to play. When David finally got into the game he noticed that the competition was fiercer than usual. The reason was that no one wanted to lose because the losers had to sit out.

David responded to the heightened competition by playing more vigorously himself. Coming down from a rebound, his elbow collided solidly with Kevin Yansen’s nose.

David stopped mid-stride, turning in time to see Kevin cradling his nose in both hands. Blood was dripping between his fingers.

“Kevin,” David called in alarm. “Are you all right?”

“Chrissake,” Kevin snarled through his cupped hands. “You ass!”

“I’m sorry,” David said. He felt embarrassed at his own aggressiveness. “Let me see.” David reached out and tried to ease Kevin’s hands away from his face.

“Don’t touch me,” Kevin snapped.

“Come on, Mr. Aggressive,” Trent Yarborough called from across the floor. Trent was a surgeon and one of the better ballplayers. He’d played at Yale. “Let’s see the old schnozzola. Frankly, I’m glad to see you get a little of your own medicine.”

“Screw you, Yarborough,” Kevin said. He lowered his hands. His right nostril dripped blood. The bridge of his nose bent to the right.

Trent came over for a better look. “Looks like your beak’s been broken.”

“Shit!” Kevin said.

“Want me to straighten it?” Trent asked. “I won’t charge much.”

“Let’s just hope your malpractice insurance is paid up,” Kevin said. He tilted his head back and closed his eyes.

Trent grabbed Kevin’s nose between his thumb and the knuckle of his index finger and snapped it back into position. The cracking sound that resulted made everyone—even the surgeon—wince.

Trent stepped back to admire his handiwork. “Looks better than the original,” he said.

David asked if he could give Kevin a ride home, but Kevin told him he’d drive himself, still sounding angry.

A sub stepped into the game, taking Kevin’s place. For a moment David stood and gazed at the door where Kevin had exited. Then he winced as someone slapped him on the back. David turned and looked into Trent’s face.

“Don’t let Kevin bother you,” Trent said. “He’s broken two other people’s noses here that I know of. Kevin is not a particularly good sport, but otherwise he’s okay.”

Reluctantly, David resumed the game.

When David returned home, Nikki and Angela were ready for the day’s outing. There were to be no projects that Saturday because they had been invited to a nearby lake for an overnight stay. An afternoon of swimming was to be followed by a cookout. The Yansens, the Yarboroughs, and the Youngs, the “three Y’s” as they called themselves, had rented a lakeside cottage for the month. Steve Young was an obstetrician/gynecologist as well as one of the basketball regulars.

“Come on, Daddy,” Nikki said impatiently. “We’re already late.”

David looked at the time. He’d played basketball longer than usual. Running upstairs, he jumped into the shower. A half hour later they were in the car and on their way.

The lake was an emerald green jewel nestled into a lushly wooded valley between two mountains. One of the mountains boasted a ski resort that David and Angela were told was one of the best in the area.

The cottage was charming. It was a rambling, multi-bedroomed structure built around a massive fieldstone fireplace. A spacious screened porch fronted the entire house and faced the lake. Extending out from the porch was a large deck. A flight of wooden steps connected the deck to a T-shaped dock that ran out fifty feet into the water.

Nikki immediately teamed up with Arni Yansen, and they ran off into the forest where Arni was eager to show her a treehouse. Angela went into the kitchen where Nancy Yansen, Claire Young, and Gayle Yarborough were happily involved in the food preparation. David joined the men who were nursing beers while casually watching a Red Sox game on a portable TV.

The afternoon passed languidly, interrupted only by the minor tragedies associated with eight active children who had the usual proclivities of tripping over rocks, skinning knees, and hurting each others’ feelings. The Yansens had two children, the Youngs had one, and the Yarboroughs had three.

The only blip in the otherwise flawless day was Kevin’s mood. He’d developed mildly black eyes from his broken nose. On more than one occasion he yelled at David for being clumsy and fouling him continuously. David finally took him aside, amazed that Kevin was making such an issue of the affair.

“I apologized,” David said. “And I’ll apologize again. I’m sorry. It was an accident. I certainly didn’t mean it.”

Kevin irritably eyed David, giving David the impression that Kevin was not going to forgive him. But then Kevin sighed. “All right,” he said. “Let’s have another beer.”

After dinner the adults sat around the huge table while the children went out onto the dock to fish. The sky was still red in the west and the color reflected off the water. The tree frogs and crickets and other insects had long since started their incessant nightly chorus. Fireflies dotted the deep shadows under the trees.

At first the conversation dealt with the beauty of the surroundings and the inherent benefits of living in Vermont where most people only got to visit for short vacations. But then the conversation turned to medicine, to the chagrin of the other three wives.

“I’d almost rather hear sports trivia,” Gayle Yarborough complained. Nancy Yansen and Claire Young heartily agreed.

“It’s hard not to talk about medicine with all this so-called ‘reform’ going on,” Trent said. Neither Trent nor Steve were CMV physicians. Although they had been trying to form a preferred provider organization with a large insurance company and Blue Shield, they were not having much luck. They were a little late. Most of the patient base had been snapped up by CMV because of the plan’s aggressive, competitive marketing.

“The whole business has got me depressed,” Steve said. “If I could think of some way of supporting myself and my family, I’d leave medicine in the blink of an eye.”

“That would be a terrible waste of your skill,” Angela said.

“I suppose,” Steve said. “But it would be a hell of a lot better than blowing my brains out like you-know-who.”

The reference to Dr. Portland intimidated everyone for a few moments. It was Angela who broke the silence. “We’ve never heard the story about Dr. Portland,” she said. “I’ve been curious, I have to admit. I’ve seen his poor wife. She’s obviously having enormous trouble dealing with his death.”

“She blames herself,” Gayle Yarborough said.

“All we heard was that he was depressed,” David said. “Was it about something specific?”

“The last time he played basketball he was all uptight about one of his hip fracture patients dying,” Trent said. “It was Sam Flemming, the artist. Then I think he lost a couple of others.”

David felt a shiver pass down his spine. The memory of his own reaction as a junior resident to the deaths of several of his patients passed through him like an unwelcome chill.

“I’m not even sure he killed himself,” Kevin said suddenly, shocking everyone. Other than complaining about David’s clumsiness, Kevin had said very little that day. Even his wife Nancy looked at him as if he’d blasphemed.

“I think you’d better explain yourself,” Trent said.

“Not much to explain except Randy didn’t have a gun,” Kevin said. “It’s one of those nagging details that no one has been able to explain. Where’d he get it? No one has stepped forward to say that he’d borrowed it from him. He didn’t go out of town. What did he do, find it along the road?” Kevin laughed hollowly. “Think about it.”

“Come on,” Steve said. “He must have had it, just no one knew.”

“Arlene said she didn’t know anything about it,” Kevin persisted. “Plus he was shot directly through the front of the head and angled downward. That’s why it was his cerebellum that was splattered against the wall. I’ve personally never heard of anyone shooting himself like that. People usually put the barrel in their mouths if they want to be sure not to mess it up. Other people shoot themselves in the side of the head. It’s hard to shoot yourself from the front, especially with a long-barreled magnum.” Kevin made a pistol with his hand as he’d done on David’s first day of work. This time when he tried to point the gun straight into his forehead, he made the gesture look particularly awkward.

Gayle shivered through fleeting nausea. Even though she was married to a doctor, talk of blood and guts made her ill.

“Are you trying to suggest he was murdered?” Steve said.

“All I’m saying is I’m personally not sure he killed himself,” Kevin repeated. “Beyond that, everybody can make his own assessment.”

The sounds of crickets and tree frogs dominated the night as everyone pondered Kevin’s disturbing comments. “Well, I think it’s all poppycock,” Gayle Yarborough said finally. “I think it was cowardly suicide, and my heart goes out to Arlene and her two boys.”

“I agree,” Claire Young said.

Another uncomfortable silence followed until Steve broke it: “What about you two?” he asked, looking across the table at Angela and David. “How are you finding Bartlet? Are you enjoying yourselves?”

David and Angela exchanged glances. David spoke first: “I’m enjoying it immensely,” he said. “I love the town, and since I’m already part of CMV I don’t have to worry about medical politics. I walked into a big practice, maybe a little too big. I’ve got more oncology patients than I’d anticipated and more than I’d like.”

“What’s oncology?” Nancy Yansen asked.

Kevin gave his wife an irritated look of disbelief. “Cancer,” he said disdainfully. “Jesus, Nance, you know that.”

“Sorry,” Nancy said with equal irritation.

“How many oncology patients do you have?” Steve asked.

David closed his eyes and thought for a moment. “Let’s see,” he said. “I’ve got John Tarlow with leukemia. He’s in the hospital right now. I’ve got Mary Ann Schiller with ovarian cancer. I’ve got Jonathan Eakins with prostatic cancer. I’ve got Donald Anderson who they thought had pancreatic cancer but who ended up with a benign adenoma.”

“I recognize that name,” Trent said. “That patient had a Whipple procedure.”

“Thanks for telling us,” Gayle said sarcastically.

“That’s only four patients,” Steve said.

“There’s more,” David said. “I’ve also got Sandra Hascher with melanoma and Marjorie Kleber with breast cancer.”

“I’m impressed you’ve committed them all to memory,” Claire Young said.

“It’s easy,” David said. “I remember them because I’ve befriended them all. I see them on a regular basis because they have a lot of medical problems, which is hardly surprising considering the amount of treatment they’ve undergone.”

“Well, what’s the problem?” Claire asked.

“The problem is that now that I’ve befriended them and accepted responsibility for their care, I’m worried they’ll die of their illness and I’ll feel responsible.”

“I know exactly what he means,” Steve said. “I don’t understand how anybody can go into oncology. God bless them. Half the reason I went into OB was because it’s generally a happy specialty.”

“Ditto for ophthalmology,” Kevin said.

“I disagree,” Angela said. “I can understand very well why people go into oncology. It has to be rewarding because people with potentially terminal illnesses have great needs. With a lot of other specialties you never truly know if you have helped your patients or not. There’s never a question with oncology.”

“I know Marjorie Kleber quite well,” Gayle Yarborough said. “Both TJ and my middle, Chandler, had her as their teacher. She’s a marvelous woman. She had this creative way to get the kids interested in spelling with tiny plastic airplanes moving across a wall chart.”

“I enjoy seeing her every time she conies in for an appointment,” David admitted.

“How’s your job?” Nancy Yansen asked Angela.

“Couldn’t be better,” Angela said. “Dr. Wadley, the chief of the department, has become a true mentor. The equipment is state-of-the-art. We’re busy but not buried. We’re doing between five hundred and a thousand biopsies a month, which is respectable. We see interesting pathology because Bartlet Hospital is acting as a tertiary care center. We even have a viral lab which I didn’t expect. So all in all it’s quite challenging.”

“Have you had any run-ins with Charles Kelley yet?” Kevin asked David.

“Not at all,” David said with surprise. “We’ve gotten along fine. In fact just this week I met with Kelley and the CMV quality management director from Burlington. They were both complimentary about the responses patients had given on forms asking them to evaluate care and satisfaction.”

“Ha!” Kevin laughed scornfully. “Quality management is a piece of cake. Wait until you have your utilization review. It usually takes two or three months. Let me know what you think of Charles Kelley then.”

“I’m not concerned,” David said. “I’m practicing good, careful medicine. I don’t give a hoot about the bonus program concerning hospitalization and I’m certainly not in the running for one of the grand prize trips to the Bahamas.”

“I wouldn’t mind,” Kevin said. “I think it’s a good program. Why not think twice before hospitalizing someone? Patients around here follow your orders. People are better off home than in the hospital. If the hospital wants to send Nance and me to the Bahamas, I’m not going to complain.”

“It’s a bit different for ophthalmology than for internal medicine,” David said.

“Enough of this medical talk,” Gayle Yarborough said. “I was just thinking we should have brought the movie The Big Chill. It’s a great movie to watch with a group like this.”

“Now that would stimulate some discussion,” Nancy Yansen said. “And it would be a lot more stimulating than this medical drivel.”

“I don’t need the movie to think about whether I would be willing to let my husband make love to one of my friends so she could have a baby,” Claire Young said. “No way, period!”

“Oh, come on,” Steve said, sitting up from his slouch. “I wouldn’t mind, especially if it were Gayle.” He reached over and gave Gayle a hug. Gayle was sitting next to him. She giggled and pretended to squirm in his arms.

Trent poured a bit of beer over the top of Steve’s head. Steve tried to catch it with his tongue.

“It would have to be a desperate situation,” Nancy Yansen said. “Besides, there’s always the turkey baster.”

For the next several minutes everyone except David and Angela doubled up with laughter. Then followed a series of off-color jokes and sexual innuendoes. David and Angela maintained half smiles and nodded at punch lines, but they didn’t participate.

“Wait a minute, everybody,” Nancy Yansen said amid laughter after a particularly salacious doctor’s joke. She struggled to contain herself. “I think we should get the kids off to bed so we can have ourselves a skinny dip. What do you say?”

“I say let’s do it,” Trent said as he clicked beer bottles with Steve.

David and Angela eyed each other, wondering if the suggestion was another joke. Everyone else stood up and started calling for their children who were still down on the dock fishing in the darkness.

Later in their room as Angela washed her face at the wall sink she complained to David that she thought the group had suddenly regressed to some early, adolescent stage. As she spoke they both could hear the rest of the adults leaping from the dock amid giggles, shouts, and splashing.

“It does smack of college fraternity behavior,” David agreed. “But I don’t think there’s any harm. We shouldn’t be judgmental,”

“I’m not so sure,” Angela said. “What worries me is feeling that we’re in a John Updike novel about suburbia. All that loose sexual talk and now this acting out makes me uncomfortable. I think it could be a reflection of boredom. Maybe Bartlet isn’t the Eden we think it is.”

“Oh, please!” David said with amazement. “I think you’re being overly critical and cynical. I think they just have an exuberant, fun-loving, youthful attitude toward life. Maybe we’re the ones with hang-ups.”

Angela turned from the sink to face David. Her expression was one of surprise, as if David were a stranger. “You’re entirely welcome to go out there naked and join the Bacchanalia if you so desire,” she said. “Don’t let me stop you!”

“Don’t get all bent out of shape,” David said. “I don’t want to participate. But at the same time I don’t see it in such black and white terms as you apparently do. Maybe it’s some of your Catholic baggage.”

“I refuse to be provoked,” Angela said, turning back to the sink. “And I specifically refuse to be baited into one of our pointless religious discussions.”

“Fine by me,” David said agreeably.

Later when they had gotten into bed and turned out the light the sounds of merriment from the dock had been replaced by the frogs and insects. It was so quiet they could hear the water lapping against the shore.

“Do you think they’re still out there?” Angela whispered.

“I haven’t the faintest idea,” David said. “Moreover I don’t care.”

“What did you think of Kevin’s comments about Dr. Portland?” Angela asked.

“I don’t know what to think,” David said. “To be truthful, Kevin has become somewhat of a mystery to me. He’s a weird duck. I’ve never seen anyone carry on so much about getting bumped in the nose in a pickup basketball game.”

“I found his comments unsettling to say the least,” Angela said. “Thinking about murder in Bartlet even for a second leaves me strangely cold. I’m beginning to have this uncomfortable nagging feeling that something bad is going to happen, maybe because we’re too happy.”

“It’s that hysterical personality of yours,” David said, half in jest. “You’re always looking for the dramatic. It makes you pessimistic. I think we’re happy because we made the right decision.”

“I hope you are right,” Angela said as she snuggled into the crook of David’s arm.

Traynor pulled his Mercedes off the road and bumped across the field toward the line of cars parked near a split-rail fence. During the summer months, the fairgrounds beyond the fence were used most often for crafts fairs, but today Traynor and his wife, Jacqueline, were headed there for the eighth annual Bartlet Community Hospital Labor Day picnic. Festivities had begun at nine starting with field day races for the children.

“What a way to ruin a perfectly good holiday,” Traynor said to his wife. “I hate these picnics.”

“Fiddlesticks!” Jacqueline snorted. “You don’t fool me for a second.” She was a petite woman, mildly overweight, who dressed inordinately conservatively. She was wearing a white hat, white gloves, and heels even though the outing was a cookout with corn, steamed clams, and Maine lobster.

“What are you talking about?” Traynor asked as he pulled to a stop and turned off the ignition.

“I know how much you love these hospital affairs, so don’t play martyr with me. You love basking in the limelight. You play your part of Mr. Chairman of the Board to the hilt.”

Traynor eyed his wife indignantly. Their marriage was filled with antagonism, and it was his routine to lash back, but he held his tongue. Jacqueline was right about the picnic, and it irritated him that over their twenty-one years of marriage, she’d come to know him so well.

“What’s the story?” Jacqueline asked. “Are we going to the affair or not?”

Traynor grunted and got out of the car.

As they trudged back along the line of parked cars, Traynor saw Beaton who waved and started to come to meet them. She was with Wayne Robertson, the chief of police, and Traynor immediately suspected something was wrong.

“How convenient,” Jacqueline said, seeing Beaton approach. “Here comes one of your biggest sycophants.”

“Shut up, Jacqueline!” Traynor snarled under his breath.

“I’ve got some bad news,” Beaton said without preamble.

“Why don’t you head over to the tent and get some refreshments,” Traynor told Jacqueline. He gave her a nudge. After she tossed Beaton a disparaging look, she left.

“She seems less than happy to be here this morning,” Beaton commented.

Traynor gave a short laugh of dismissal. “What’s the bad news?”

“I’m afraid there was another assault on a nurse last night,” Beaton said. “Or rather, this morning. The woman was raped.”

“Damn it all!” Traynor snarled. “Was it the same guy?”

“We believe so,” Robertson said. “Same description. Also the same ski mask. This time the weapon was a gun rather than a knife, but he still had the handcuffs. He also forced her into the trees which is what he’s done in the past.”

“I’d hoped the lighting would have prevented it,” Traynor said.

“It might have,” Beaton said hesitantly.

“What do you mean?” Traynor demanded.

“The assault occurred in the upper lot, where there are no lights. As you remember, we illuminated only the lower lot to save money.”

“Who knows about this rape?” Traynor asked.

“Not very many people,” Beaton said. “I took it upon myself to contact George O’Donald at the Bartlet Sun, and he’s agreed to keep it out of the paper. So we might get a break. I know the victim’s not about to tell many people.”

“I’d like to keep it away from CMV if it’s at all possible,” Traynor said.

“I think this underlines how much we need that new garage,” Beaton said.

“We need it, but we might not get it,” Traynor said. “That’s my bad news for tonight’s executive meeting. My old nemesis, Jeb Wiggins, has changed his mind. Worse still, he’s convinced the Board of Selectmen that the new garage is a bad idea. He’s got them all convinced it would be an eyesore.”

“Is that the end of the project?” Beaton asked.

“It’s not the end, but it’s a blow,” Traynor admitted. “I’ll be able to get it on the ballot again, but once something like this gets turned down, it’s hard to resurrect it. Maybe this rape, as bad as it is, could be the catalyst we need to get it to pass.”

Traynor turned to Robertson. Traynor could see two bloated images of himself in Robertson’s mirrored sunglasses. “Can’t the police do anything?” he asked.

“Short of putting a deputy up there on a nightly basis,” Robertson said, “there’s not much we can do. I already have my men sweep the lots with their lights whenever they’re in the area.”

“Where’s the hospital security man, Patrick Swegler?” Traynor asked.

“I’ll get him,” Robertson said. He jogged off toward the pond.

“Are you ready for tonight?” Traynor asked once Robertson was out of earshot.

“You mean for the meeting?” Beaton asked.

“The meeting and after the meeting,” Traynor said with a lascivious smile.

“I’m not sure about after,” Beaton said. “We need to talk.”

“Talk about what?” Traynor asked. This was not what he wanted to hear.

“Now isn’t a good time,” Beaton said. She could already see Patrick Swegler and Wayne Robertson on their way over.

Traynor leaned against the fence. He felt a little weak. The one thing he counted on was Beaton’s affection. He wondered if she were cheating on him, seeing someone like that ass Charles Kelley. Traynor sighed; there was always something wrong.

Patrick Swegler approached Traynor and looked him squarely in the eye. Traynor thought of him as a tough kid. He’d played football for Bartlet High School during the brief era that Bartlet dominated their interscholastic league.

“There wasn’t much we could have done,” Swegler said, refusing to be intimidated about the incident. “The nurse had done a double shift and she did not call security before she left as we’d repeatedly instructed nurses to do whenever they leave late. To make matters worse, she’d parked in the upper lot when she’d come to work for the day shift. As you know, the upper lot is not illuminated.”

“Jesus H. Christ!” Traynor muttered. “I’m supposed to be supervising the running of a multimillion-dollar operation, and I’ve got to worry about the most mundane details. Why didn’t she call security?”

“I wasn’t told, sir,” Swegler said.

“If we get the new garage, the problem will be over,” Beaton said.

“Where’s Werner Van Slyke of engineering?” Traynor said. “Get him over here.”

“You of all people know Mr. Van Slyke doesn’t attend any of the hospital’s social functions,” Beaton said.

“Dammit, you’re right!” Traynor said. “But I want you to tell him for me that I want that upper parking lot lit just like the lower. In fact, tell him to light it up like a ballfield.”

Traynor then turned back to Robertson. “And why haven’t you been able to find out who this goddamn rapist is, anyway? Considering the size of the town and the number of rapes all presumably by the same person, I’d think you’d have at least one suspect.”

“We’re working on it,” Robertson said.

“Would you like to head over to the tent?” Beaton asked.

“Why not?” Traynor fumed. “At least I’d like to get a few clams out of this.” Traynor took Beaton by the arm and headed for the food.

Traynor was about to get back to the subject of their proposed rendezvous when Caldwell and Cantor spotted them and approached. Caldwell was in a particularly cheerful mood.

“I guess you’ve already heard how well the bonus program is working,” he said to Traynor. “The August figures are encouraging.”

“No, I haven’t heard,” Traynor said, turning to Beaton.

“It’s true,” Beaton said. “I’ll be presenting the stats tonight. The balance sheet is okay. August CMV admissions are down four percent over last August. That’s not a lot, but it’s in the right direction.”

“It’s warming to hear some good news once in a while,” Traynor said. “But we can’t relax. I was talking with Arnsworth on Friday, and he warned me that the red ink will reappear with a vengeance when the tourists leave. In July and August a good portion of the hospital census has been paying patients, not CMV subscribers. Now that it’s past Labor Day, the tourists will be going home. So we cannot afford to relax.”

“I think we should reactivate our strict utilization control,” Beaton said. “It’s our only hope of holding out until the current capitation contract runs out.”

“Of course we have to recommence,” Traynor said. “We don’t have any choice. By the way, for everyone’s information, we have officially changed the name from DUM to DUC. It’s now ‘drastic utilization control.’  ”

Everyone chuckled.

“I have to say I’m disappointed,” Cantor said, still chuckling. “As the architect for the plan I was partial to DUM.” Despite the long, sunny summer his facial pallor had changed very little. The skin on his surprisingly slender legs was paler still. He was wearing bermuda shorts and black socks.

“I have a policy question,” Caldwell said. “Under DUC, what’s the status of a chronic disease like cystic fibrosis?”

“Don’t ask me,” Traynor said. “I’m no doctor. What the hell is cystic fibrosis? I mean, I’ve heard the term but that’s about all.”

“It’s a chronic inherited illness,” Cantor explained. “It causes a lot of respiratory and GI problems.”

“GI stands for gastro-intestinal,” Caldwell explained. “The digestive system.”

“Thank you,” Traynor said sarcastically. “I know what GI means. What about the illness; is it lethal?”

“Usually,” Cantor said. “But with intensive respiratory care, some of the patients can live productive lives into their fifties.”

“What’s the actuarial cost per year?” Traynor asked.

“Once the chronic respiratory problems set in it can run twenty thousand plus per year,” Cantor said.

“Good Lord!” Traynor said. “With that kind of cost, it has to be included in utilization considerations. Is it a common affliction?”

“One in every two thousand births,” Cantor said.

“Oh, hell!” Traynor said with a wave. “Then it’s too rare to get excited over.”

After promises to be prompt for the executive board meeting that night, Caldwell and Cantor went their separate ways. Caldwell headed over to a volleyball game in the process of forming on the tiny beach at the edge of the pond. Cantor made a beeline for the tub of iced beer.

“Let’s get to the food,” Traynor said.

Once again they set out toward the tent that covered the rows of charcoal grills. Everyone Traynor passed either nodded or called out a greeting. Traynor’s wife was right: he did love this kind of public occasion. It made him feel like a king. He’d dressed casually but with decorum; tailored slacks, his elevator loafers without socks, and an open-necked short-sleeved shirt. He’d never wear shorts to such an occasion and was amazed that Cantor cared so little about his appearance.

His happiness was dampened by the approach of his wife. “Enjoying yourself, dear?” she asked sarcastically. “It certainly appears that way.”

“What am I supposed to do?” he asked rhetorically. “Walk around with a scowl?”

“I don’t see why not,” Jacqueline said. “That’s the way you are most of the time at home.”

“Maybe I should leave,” Beaton said, starting to step away.

Traynor grabbed her arm, holding her back. “No, I want to hear more about August statistics for tonight’s meeting.”

“In that case, I’ll leave,” Jacqueline said. “In fact, I think I’ll head home, Harold, dear. I’ve had a bite and spoken to the two people I care about. I’m sure one of your many colleagues will be more than happy to give you a lift.”

Traynor and Beaton watched Jacqueline totter away through the deep grass in her pumps.

“Suddenly I’m not hungry,” Traynor said after Jacqueline had disappeared from sight. “Let’s circulate some more.”

They walked down by the lake and watched the volleyball game for a while. Then they strolled toward the softball diamond.

“What is it you want to talk about?” Traynor asked, marshaling his courage.