Even though David and Angela had spent four years in Boston during their residencies, they hadn’t truly experienced the full glory of a New England fall. In Bartlet it was breathtaking. Each day the splendiferous color of the leaves became more intense, as if trying to surpass the previous day’s efforts.

Besides the visual treats, fall brought more subtle pleasures associated with a sense of well-being. The air turned crisp and crystal clear and more pure to breathe. There was a feeling of invigoration in the atmosphere that made waking up in the morning a pleasure. Each day was filled with energy and excitment; each evening offered cozy contentment, with the sound of a crackling fire to keep the nighttime chill at bay.

Nikki loved her school. Marjorie Kleber became her teacher and, as David had surmised, she was superb. Although Nikki had always been a good student, she now became an excellent one. She looked forward to Mondays when a new schoolweek would commence. At night she was full of stories about all she had learned that day in class.

Nikki’s friendship with Caroline Helmsford blossomed and the two became inseparable during after-school activities. Nikki’s friendship with Arni also grew. After much discussion of the pros and cons Nikki won the right to ride her bike to school provided she stayed off main roads. It was an entirely new type of freedom for Nikki, and one that she loved. The route took her past the Yansen house, and every morning Arni waited for her. The last mile they rode together.

Nikki’s health continued to be good. The cool, dry, clean air seemed therapeutic for her respiratory system. Except for her daily morning therapy in her beanbag chair, it was almost as if she were not afflicted by a chronic disease. The fact that she was doing so well was a source of great comfort to David and Angela.

One of the big events of the fall was the arrival of Angela’s parents in the latter part of September. Angela had felt a great amount of ambivalence about whether to invite them. David’s support had tipped the balance.

Dr. Walter Christopher, Angela’s father, was reservedly complimentary about the house and the town but condescending about what he called “rural medicine.” He stubbornly refused to visit Angela’s lab with the excuse that he spent too much of his life inside hospitals.

Bernice Christopher, Angela’s mother, found nothing to be complimentary about. She thought the house was too large and much too drafty, especially for Nikki. It was also her opinion that the color of the leaves was just as good in Central Park as in Bartlet, and that no one needed to drive six hours to look at trees.

The only truly uncomfortable episode occurred at the dinner table Saturday night. Bernice insisted on drinking more than her share of wine, and, as usual, became tipsy. She then accused David and his family of being the source of Nikki’s illness.

“There’s never been cystic fibrosis on our side,” she said.

“Bernice!” Dr. Christopher said sharply. “Displays of ignorance are unbecoming.”

Strained silence ensued until Angela managed to contain her anger. She then changed the subject to her and David’s quest for furniture in the neighboring antique and used furniture shops.

Everyone was relieved when the time of the Christophers’ departure arrived midday on Sunday. David, Angela, and Nikki dutifully stood alongside the house and waved until the Christophers’ car disappeared down the road. “Kick me next time I talk about them coming up here,” Angela said. David laughed and assured her it hadn’t been that bad.

The magnificent fall weather continued well into October. Although there had been some cool days in late September, Indian summer arrived and brought days as warm as those of summer itself. An auspicious combination of temperature and moisture preserved the peak foliage long after what the Bartlet natives said was usual.

In mid-October during a break in Saturday morning basketball, Steve, Kevin, and Trent cornered David.

“How about you and your family coming with us this weekend?” Trent said. “We’re all going over to Waterville Valley in New Hampshire. We’d love to have you guys come along.”

“Tell him the real reason we want them to come,” Kevin said.

“Shut up!” Trent said, playfully rapping Kevin on the top of his head.

“The real reason is that we’ve rented a condo with four bedrooms,” Kevin persisted, ducking away from Trent. “These tightwads will do anything to reduce the cost.”

“Bull,” Steve said. “The more people the more fun.”

“Why are you going to New Hampshire?” David asked.

“It’ll be the last weekend for foliage for sure,” Trent said. “It’s different over in New Hampshire. More rugged scenery. Some people think the foliage is even more spectacular there.”

“I can’t imagine it could be any prettier than it is right here in Bartlet,” David said.

“Waterville’s fun,” Kevin said. “Most people know it only for winter skiing. But it’s got tennis, golf, hiking, even a basketball court. The kids love it.”

“Come on, David,” Steve said. “Winter will be here soon enough. You’ve got to get out and take advantage of fall as long as possible. Trust us.”

“It sounds okay to me,” David said. “I’ll run it by Angela tonight, and I’ll give one of you guys a call.”

With that decided, the group joined the others to finish their basketball game.

That night Angela was not enthused when David mentioned the invitation. After the experience of the weekend at the lake combined with being busy around the house, David and Angela had not socialized much. Angela did not want to participate in another weekend of off-color jokes and sexual innuendo. Despite David’s feelings to the contrary, Angela continued to wonder if their friends were bored, especially the women, and the idea of being together in such close quarters sounded a little too claustrophobic for her.

“Come on,” David said. “It will be fun. We should see more of New England. As Steve said, winter will be here all too soon, and for the most part we’ll be imprisoned indoors.”

“It’ll be expensive,” Angela said, trying to think up reasons not to go.

“Come on, Mom,” Nikki said. “Arni told me Waterville was neat.”

“How can it be expensive?” David questioned. “We’ll be splitting the condo four ways. Besides, consider our income.”

“Consider our debt,” Angela countered. “We’ve got two mortgages on the house, one of which is a balloon, and we’ve started paying off our student loans. And I don’t know if the car will make it through a Vermont winter.”

“You’re being silly,” David said. “I’m keeping close tabs on our finances, and we are doing perfectly well. It’s not as if this is some extravagant cruise. With four families in a condo it will be no more expensive than a camping trip.”

“Come on, Mom!” Nikki cried.

“All right,” Angela said at last. “I can tell when I’m outnumbered.”

As the week progressed excitement about the trip grew. David got one of the other CMV doctors, Dudley Markham, to cover his practice. Thursday night they packed to leave the following afternoon.

The initial plan was to leave at three p.m., but the difficulties of getting five doctors away from the hospital in the middle of the afternoon proved impossible to overcome. It wasn’t until after six that they actually departed.

They took three vehicles. The Yarboroughs took their own van with their three children; the Yansens and Youngs doubled up in the Yansens’ van; David, Angela, and Nikki took the Volvo. They could have squeezed in with the Yarboroughs, but Angela liked the independence of having their own vehicle.

The condo was enormous. Besides the four bedrooms, there was an upper loft where the kids could sleep in sleeping bags. After the trip everyone was tired. They headed straight for bed.

The next morning, Gayle Yarborough took it upon herself to wake everyone early. She marched through the house drumming a wooden spoon on the bottom of a saucepan, calling out that they were to leave for breakfast in half an hour.

Half an hour turned out to be an optimistic estimate of the time of departure. Although there were four bedrooms and a sleeping loft, there were only three and a half baths. Showers, hair drying, and shaving were a traffic control nightmare. On top of that, Nikki had to do her postural drainage. It was almost an hour and a half before the group was ready to go.

Climbing into the vehicles in the same order as the night before, they motored out of the valley with its circle of mountains and headed up Interstate 93. Driving through Franconia Notch both David and Angela were taken by the riotous beauty of the fall foliage silhouetted against stark, sheer walls of gray granite.

“I’m starved,” Nikki said after a half hour of driving.

“Me too,” Angela said. “Where are we going?”

“A place called Polly’s Pancake Parlor,” David said. “Trent told me it’s an institution up here in northern New Hampshire.”

Arriving at the restaurant, they were informed there would be a forty-minute wait for a table. Fortunately, as soon as they finally started eating, everybody said the wait had been worth it. The pancakes, smothered in pure New Hampshire maple syrup, were delicious, as were the smoked bacon and sausage.

After breakfast they toured around New Hampshire looking at the leaves and the mountain scenery. There were arguments about whether the fall foliage was better in Vermont or New Hampshire. No one won. As Angela said, it was like comparing superlatives.

As they drove back toward Waterville Valley on a particularly scenic stretch of road called the Kancamagus Highway, David noticed that high cirrus clouds had drifted over the vast dome of the sky. By the time they got back to Waterville the clouds were thicker, effectively blocking out the sun and causing the temperature to plummet into the mid-fifties.

Once they were back at the condo, Kevin was eager for a game of tennis. No one was interested, but he managed to talk David into playing. After driving most of the day, David thought that some exercise would do him good.

Kevin was an accomplished player, and he usually beat David with relative ease. But on this particular occasion, he wasn’t up to his usual game. To Kevin’s chagrin, David began winning.

With his keen competitive nature, Kevin tried harder, but his intensity only caused him to make more mistakes. He began getting angry at himself, then at David. When David called a shot out, Kevin dropped his racket in a show of disbelief.

“That was not out,” Kevin yelled.

“It was,” David answered. David circled the mark in the clay with his racket. Kevin walked all the way around the net to look.

“That wasn’t the mark,” Kevin said angrily.

David looked at his officemate. He could see the man was angry. “Okay,” David said, hoping to defuse the tension. “Why don’t we play the point over?”

When they replayed the point David won again, and in an attempt to lighten the atmosphere, he called out: “Cheating shows.”

“Screw you,” Kevin called back. “Serve the ball!”

Any enjoyment that David derived from the game was destroyed by Kevin’s poor attitude. Kevin got more and more angry, contesting almost all of David’s calls. David suggested they stop. Kevin insisted they play to the bitter end. They did and David won.

Walking back to the condo Kevin refused to talk, and David gave up trying to make conversation. A few sprinkles urged them on. When they arrived Kevin went into one of the bathrooms and slammed the door. Everyone looked at David. David shrugged. “I won,” he said and felt strangely guilty.

Despite a cheerful fire, plenty of good food, and lots of beer and wine, the evening was overshadowed by Kevin’s gloom. Even his wife, Nancy, told him he was acting childish. The comment sparked a nasty exchange between husband and wife that left everyone feeling uncomfortable.

Eventually Kevin’s despondency spread. Trent and Steve began to lament that their practices had fallen to a point where they had to think seriously of leaving Bartlet. CMV had already hired people in their specialties.

“A lot of my former patients have told me they’d like to come back to me,” Steve said, “but they can’t. Their employers have negotiated with CMV for health coverage. If these patients see me they have to pay out of their pockets. It’s a bad scene.”

“Maybe you’re better off getting the hell out while you can,” Kevin said, speaking up for the first time without having been specifically spoken to.

“Now that’s a sufficiently cryptic comment to beg an explanation,” Trent said. “Does Dr. Doom and Gloom have some privileged information that we mortals are unaware of?”

“You wouldn’t believe me if I told you,” Kevin said while staring into the fire. The glow of the embers reflected off the surface of his thick glasses, giving him an eerie, eyeless appearance.

“Try us,” Steve encouraged.

David glanced at Angela to see how she was faring amid this depressing evening. As far as David was concerned he found the experience much more disturbing than the one at the lake in August. He could handle sexual innuendo and crude jokes, but he had a lot of trouble with hostility and despondency, especially when it was openly expressed.

“I’ve learned a little more about Randy Portland,” Kevin said without taking his eyes away from the fire. “But you people wouldn’t believe any of it. Not after the way you responded to my suggestion that maybe his death wasn’t suicide.”

“Come on, Kevin,” Trent said. “Stop making such a damn production out of this. Tell us what you heard.”

“I had lunch with Michael Caldwell,” Kevin said. “He wants me to serve on one of his innumerable committees. He told me that the chairman of the hospital board, Harold Traynor, had had a weird conversation with Portland the day he died. And Traynor related what was said to Charles Kelley.”

“Yansen, get to the point,” Trent said.

“Portland said there was something wrong with the hospital.”

Trent’s mouth dropped open in mock horror. “Something is wrong with the hospital? I’m shocked, just shocked.” Trent shook his head. “Good gravy, man, there’s plenty wrong with the hospital. If that’s the payoff to this story, I’m not exactly impressed.”

“There was more,” Kevin said. “Portland told Traynor that he wouldn’t take the blame.”

Trent looked at Steve. “Am I missing something here?”

“Was Portland referring to a patient when he was making these claims?” Steve asked.

“Obviously,” Kevin said. “But that’s too subtle for a surgeon like Trent to pick up. What’s clear to me is that Portland thought that something weird was going on with one of his patients. I think he should have kept his mouth shut. If he had, he’d probably still be around today.”

“Sounds like Portland was just getting paranoid,” Trent said. “He was already depressed. I don’t buy it. You’re trying to make a conspiracy out of nothing. What did Portland’s patient die of, anyway?”

“Pneumonia and endotoxin shock,” Steve said. “That’s how it was presented in death conference.”

“There you go,” Trent said. “There’s not a lot of mystery about a death when there’s a bunch of gram-negative bacteria running around in the corpse’s bloodstream. Sorry, Kev, you haven’t convinced me.”

Kevin stood up suddenly. “Why do I bother?” he said, throwing up his hands. “You’re all blind as bats. But you know something? I don’t give a rat’s ass.”

Stepping over Gayle, who’d sprawled on the floor in front of the fire, Kevin stomped up the half flight of stairs to the bedroom he and Nancy were occupying. He slammed the door behind him hard enough to rattle the bric-a-brac on the wooden mantel.

Everyone stared into the fire. No one spoke. Rain could be heard hitting the skylight like so many grains of rice. Finally Nancy stood up and said she’d be turning in.

“Sorry about Kevin,” Trent said. “I didn’t mean to provoke him.”

“It’s not your fault,” Nancy said. “He’s been a bear lately. There’s something he didn’t tell you. He recently lost a patient himself—which isn’t exactly a common occurrence for an ophthalmologist.”

The next day they woke to gusty wind, a heavy mist, and a cold, driving rain. When Angela looked out the window, she cried out for David. Fearing some catastrophe, David leaped from the bed. With heavily lidded eyes he looked out. He saw the car. He saw the rain.

“What am I supposed to be seeing?” he asked sleepily.

“The trees,” Angela said. “They’re bare. There are no leaves. All the foliage has vanished in one night!”

“It must have been the wind,” David said. “It rattled the storm windows all night.” He dropped onto the bed and burrowed back under the comforter.

Angela stayed at the window, captivated by the skeletal remains of the trees. “They all look dead,” she said. “I can’t believe what a difference it makes. It’s hard not to see it as an omen. It adds to that feeling I’ve had that something bad is going to happen.”

“It’s melancholia left over from last night’s conversational requiem,” David said. “Don’t get morbidly dramatic on me. It’s too early. Come on back to bed for a few minutes.”

The next shock was the temperature. Even by nine in the morning it was still in the thirties. Winter was on its way.

The gloomy weather did not improve the general moodiness of the adults, who’d awakened with the same sullenness they’d taken to bed. The children were initially happy, although even they started to be affected by their parents’ ill humor. David and Angela were relieved to get away. As they drove down the mountain David asked Angela to remind him never to play tennis with Kevin again.

“You men can be such children with your sports,” Angela said.

“Hey!” David snapped. “I wasn’t the problem. He was the problem. He’s so competitive. I didn’t even want to play.”

“Don’t get so riled up,” Angela said.

“I resent you implying I was at fault,” David said.

“I wasn’t implying anything of the kind,” Angela said. “I was merely making a comment about men and their sports.”

“All right, I’m sorry,” David said. “I suppose I’m a bit out of sorts. It drives me crazy to be around morose people. This wasn’t the most fun weekend.”

“It’s a strange group of people,” Angela said. “They seem normal on the surface, yet underneath I’m not so sure. But at least they didn’t get into any sexual discussions or start acting out like at the lake. On the other hand they did manage to dredge up the Portland tragedy again. It’s like an obsession with Kevin.”

“Kevin’s weird,” David said. “That’s what I’ve been trying to tell you. I hate to be reminded of Portland’s suicide. It makes going into my office an ordeal. Whenever he brings it up, I can’t help but picture what the wall must have looked like behind my desk, splattered with blood and brains.”

“David,” Angela said sharply. “Please! If you don’t have any concern for my sensibilities, think about Nikki’s.”

David glanced into the rearview mirror at Nikki. She was staring ahead without moving.

“You all right, Nikki?” David asked.

“My throat hurts,” Nikki said. “I don’t feel good.”

“Oh, no!” Angela said. She turned around and looked at her daughter. She reached out and put the back of her hand to Nikki’s forehead.

“And you insisted on going on this stupid trip,” Angela muttered.

David started to defend himself, but changed his mind. He didn’t want to get into an argument. He already felt irritable enough.

Nikki did not have a good night, nor did her parents. Angela was particularly distressed. By the wee hours of morning it was clear that Nikki was becoming progressively more congested. Well before dawn Angela tried the usual postural drainage combined with percussion. When they were through, she listened to Nikki’s chest with her stethoscope. She heard rales and rhonchi, sounds that meant Nikki’s breathing tubes were becoming clogged with mucus.

Before 8:00 a.m., David and Angela called their respective offices to explain that they would be late. Bundling Nikki in multiple layers of clothing, they took her to see Dr. Pilsner. Initially their reception was not encouraging. The receptionist informed them that Dr. Pilsner had a full schedule. Nikki would have to return the following day.

Angela was not to be denied. She told the receptionist that she was Dr. Wilson from pathology and that she wanted to talk with Dr. Pilsner. The receptionist disappeared into the interior of the office. Dr. Pilsner himself appeared a moment later and apologized.

“My girl thought you folks were just the usual CMV subscriber,” Dr. Pilsner explained. “What’s the problem?”

Angela told the doctor how a sore throat had led to congestion overnight and that the congestion did not respond to the usual postural drainage. Dr. Pilsner took Nikki into one of the examining rooms and listened to her chest.

“Definitely clogged up,” he said, removing the stethoscope from his ears. Then, giving Nikki’s cheek a playful pinch, he asked her how she felt.

“I don’t feel good,” Nikki said. Her breathing was labored.

“She’s been doing so well,” Angela said.

“We’ll have her back to normal in a wink,” Dr. Pilsner said, stroking his white beard. “But I think we’d better admit her. I want to start intravenous antibiotics and some intensive respiratory therapy.”

“Whatever it takes,” David said. He stroked Nikki’s hair. He felt guilty for having insisted on the New Hampshire weekend.

Janice Sperling in admissions recognized both David and Angela. She commiserated with them about their daughter.

“We’ve got a nice room for you,” she said to Nikki. “It has a beautiful view of the mountains.”

Nikki nodded and allowed Janice to slip on a plastic identification bracelet. David checked it. The room was 204, one that indeed had a particularly pleasant view.

Thanks to Janice, the admitting procedure went smoothly. In only a few minutes they were on their way upstairs. Janice led them to room 204 and opened the door.

“Excuse me,” Janice said with confusion. Room 204 was already occupied; there was a patient in the bed.

“Mrs. Kleber,” Nikki said with surprise.

“Marjorie?” David questioned. “What on earth are you doing in here?”

“Just my luck,” Marjorie said. “The one weekend you go away, I have trouble. But Dr. Markham was very kind.”

“I’m so sorry to bother you,” Janice said to Marjorie. “I can’t understand why the computer gave me room 204 when it was already occupied.”

“No trouble,” Marjorie said. “I like the company.”

David told Marjorie he’d be back shortly. The Wilsons followed Janice to the nurses’ station where she phoned admitting.

“I want to apologize for the mix-up,” Janice said after the call. “We’ll put Nikki in room 212.”

Within minutes of their arrival in room 212, a team of nurses and technicians appeared and attended to Nikki. Antibiotics were started, and the respiratory therapist was paged.

When everything was under control, David told Nikki he’d be back to check on her periodically throughout the day. He also told her to do everything the nurses and the technicians asked her to do. He gave Angela a peck on the cheek, Nikki one on the forehead, and was on his way.

David returned directly to Marjorie’s room and gazed down at his patient. She’d become one of his favorites over the months. She appeared tiny in the large orthopedic bed. David thought that Nikki would have been dwarfed.

“Okay,” David said, feigning anger, “what’s the story here?”

“It started on Friday afternoon,” Marjorie said. “Problems always start on Friday when you are reluctant to call the doctor. I didn’t feel well at all. By Saturday morning my right leg started to hurt. When I called your office they switched me to Dr. Markham. He saw me right away. He said I had phlebitis and that I had to go into the hospital to get antibiotics.”

David examined Marjorie and confirmed the diagnosis.

“You think it was necessary for me to come into the hospital?” Marjorie asked.

“Absolutely,” David assured her. “We don’t like to take chances with phlebitis. Inflammation of veins goes hand in hand with blood clots. But it’s looking good. I’d guess it’s already improved.”

“There’s no doubt it’s improved,” Marjorie said. “It feels twenty times better than it did when I came in on Saturday.”

Although he was already late getting to the office, David spent another ten minutes talking with Marjorie about her phlebitis to be sure she understood the problem. When he was finished he went to the nurses’ station and read her chart. All was in order.

Next he called Dudley Markham to thank him for covering for him over the weekend and for seeing Marjorie.

“No problem,” Dudley said. “I enjoyed Marjorie. We got to reminisce. She had my oldest in the second grade.”

Before leaving the nurses’ station David asked the head nurse, Janet Colburn, why Marjorie was in an orthopedic bed.

“No reason,” Janet said. “It just happened to be in there. At the moment, it’s not needed elsewhere. She’s better off in that one, believe me. The electronic controls to raise and lower the head and feet never break down, something I can’t say about our regular beds.”

David wrote a short note in Marjorie’s chart to make it official that he was assuming responsibility for her care; then he checked in on Nikki. She was already doing much better, even though the respiratory therapist had yet to arrive. Her improvement was probably due to hydration from her IV.

Finally, David headed over to the professional building to start seeing his patients. He was almost an hour late.

Susan was upset when David arrived. She had tried to juggle the patients’ appointments and cancel those that she could, but there were still a number waiting. David calmed her as he slipped into his office to put on his white coat. She followed him like a hound, ticking off phone messages and consult requests.

With his white jacket half on, David abruptly stopped moving. Susan halted in mid-sentence, seeing David’s face go pale.

“What’s the matter?” Susan asked with alarm.

David didn’t move or speak. He was staring at the wall behind his desk. To his tired, sleep-deprived eyes, the wall was covered with blood.

“Dr. Wilson!” Susan called. “What is it?”

David blinked and the disturbing image disappeared. Stepping over to the wall, he ran his hand over its smooth surface to reassure himself it had been a fleeting visual hallucination.

David sighed, marveling at how suggestible he’d become. He turned from the wall and apologized to Susan. “I think maybe I watched too many horror pictures when I was a kid,” he said. “My imagination is working overtime.”

“I think we better start seeing patients,” Susan said.

“I agree.”

Launching into work with gusto, David made up for lost time. By midmorning he was caught up. He took a brief time-out from seeing patients in order to return some of the phone calls. The first person he tried was Charles Kelley.

“I was wondering when you would call,” Kelley said. His voice was unusually businesslike. “I have a visitor in my office. His name is Neal Harper. He’s from CMV utilization in Burlington. I’m afraid there’s something we have to go over with you.”

“In the middle of my office hours?”

“This won’t take long,” Kelley said. “I’m afraid I must insist. Could you please come over?”

David slowly put the receiver down. Although he didn’t know why, he felt immediately anxious, as if he were a teenager being asked to come to the principal’s office.

After telling Susan where he was going, David left. As he arrived at the CMV offices, the receptionist told him to go right in.

Kelley got up from behind his desk, appearing tall and tan as usual. But his manner was different. He was serious, almost dour, a far cry from his usual ebullient self. He introduced Neal Harper, a thin, precise man with pale skin and a small amount of acne. To David he appeared the apotheosis of the bureaucrat who’d been forever locked in his office, filling out his forms.

They all sat down. Kelley picked up a pencil and played with it with both hands.

“The statistics are in for your first quarter,” Kelley said in a somber tone. “And they are not good.”

David looked back and forth between the two men, feeling increasingly anxious.

“Your productivity is not satisfactory,” Kelley continued. “You are in the lowest percentile in the whole CMV organization according to the number of patient visits per hour. Obviously you are spending entirely too much time with each patient. To make matters worse, you are in the highest percentile in ordering laboratory tests per patient from the CMV lab. As far as ordering consults from outside the CMV community, you’re completely off the graph.”

“I didn’t know these statistics were gathered,” David said lamely.

“And that’s not all,” Kelley said. “Too many of your patients have been seen in the Bartlet Community Hospital emergency room rather than in your office.”

“That’s understandable,” David said. “I’m fully booked out for two weeks plus. When someone calls with an obviously acute problem needing immediate attention, I send them to the ER.”

“Wrong!” Kelley snapped. “You don’t send patients to the ER. You see them in your office provided they’re not about to croak.”

“But such disruptions throw my schedule into a turmoil,” David said. “If I take time out to deal with emergencies, I can’t see my scheduled patients.”

“Then so be it,” Kelley said. “Or make the so-called emergency patients wait until you’ve seen the people with appointments. It’s your call, but whatever you decide, don’t use the ER.”

“Then what’s the ER for?” David asked.

“Don’t try to be a wiseass with me, Dr. Wilson,” Kelley said. “You know damn well what the ER is for. It’s for life-and-death emergencies. And that reminds me. Don’t suggest that your patients call an ambulance. CMV will not pay for an ambulance unless there is pre-approval and pre-approval is only granted in cases that are truly life-threatening.”

“Some of my patients live alone,” David said. “If they’re ill  .  .  .”

“Let’s not make this more difficult than it need be,” Kelley interrupted. “CMV doesn’t operate a bus service. All this is pretty simple. Let me spell it out for you. You must seriously increase your productivity, you must lower your use of laboratory tests drastically, you must reduce, or better yet stop, using consults outside the CMV family, and you must keep your patients out of the ER. That’s all there is to it. Understand?”

David stumbled out of the CMV office. He was flabbergasted. He’d never considered himself extravagant in the use of medical resources. He’d prided himself on always keeping the patient’s needs to the fore. Kelley’s tirade was unnerving to say the least.

Reaching his office suite, David limped inside. He caught sight of Kevin disappearing behind a closed door with a patient and remembered his prophecy about the utilization evaluation. Kevin had been right on target; it had been devastating. What also bothered David was that Kelley had not made a single reference to quality or patient approval.

“You’d better get hopping,” Susan said the instant she saw him. “You’re getting behind again.”

Midmorning Angela ducked out of the lab and went to check on Nikki. She was pleased to find her doing as well as she was. The fact that she wasn’t running a fever was particularly encouraging. There was also a definite subjective decrease in Nikki’s congestion following a prolonged visit by the respiratory therapist. Angela used a nurse’s stethoscope to listen to Nikki’s chest. There were still sounds of excessive mucus, but not nearly as much as there had been that morning.

“When can I go home?” Nikki asked.

“You just got here,” Angela said, giving Nikki’s hair a tousle. “But if you continue to improve the way you’ve been going, I’m sure Dr. Pilsner won’t want to keep you long.”

Returning to the lab, Angela went to the microbiology section to check on Nikki’s sputum swab; she wanted to make certain it had been plated. It was crucial to determine the mix of bacteria in Nikki’s respiratory tract. The technician assured her it had been done.

Returning to her office, Angela hung up her white coat in preparation to read a series of hematology slides. Just before she sat down she noticed the connecting door between her office and Wadley’s was ajar.

Angela went over to the door and peeked in. Wadley was sitting at a double-headed teaching microscope. He caught sight of her and waved for her to come over.

“This is something I want you to see,” Wadley said.

Angela stepped over to the ’scope and sat opposite her mentor. Their knees almost touched beneath the table. She put her eyes to the eyepiece and peered in. Immediately she recognized the specimen as a sample of breast tissue.

“This is a tricky case,” Wadley said. “The patient is only twenty-two years old. We have to make a diagnosis, and we have to be right. So take your time.” To make his point, he reached under the table and grasped Angela’s thigh just above the knee. “Don’t be too impulsive about your impression. Look carefully at all the ducts.”

Angela’s trained eye began to scan the slide in an orderly fashion, but her concentration faltered. Wadley’s hand had remained on her thigh. He continued talking, explaining what he thought were the key points for making the diagnosis. Angela had trouble listening. The weight of his hand made her feel acutely uncomfortable.

Wadley had touched her often in the past, and she had had occasion to touch him as well. But it had always been within acceptable social bounds, such as contact on an arm, or a pat on the back, or an exuberant hug. They had even done several “high fives” during the softball game at the Labor Day picnic. There had never been any implication of intimacy until now, when his hand remained rooted to her leg with his thumb on the inside of her thigh.

Angela wanted to move away or remove his hand, but she did neither. She kept hoping that Wadley would suddenly realize how uncomfortable she felt and withdraw. But it didn’t happen. His hand stayed on her thigh throughout a long explanation about why the biopsy had to be considered positive for cancer.

Finally Angela got up. She knew she was trembling. She bit her tongue and turned back toward her office.

“I’ll be ready to review those hematology slides as soon as you are through with them,” Wadley called after her.

Closing the connecting door between the offices, Angela went over to her desk and sank into her chair. Near tears, she cradled her face in her hands as a flood of thoughts cascaded through her mind. Going over the course of events of the previous months, she recalled all the episodes when Wadley offered to stay late to go over slides, and all the times he appeared when she had a few free moments. If she ever went to the coffee shop he appeared and always took the seat next to her. And as far as touching was concerned, now that she thought about it, he never passed up an opportunity.

All at once the mentor-like effort and demonstrative affection Wadley had been expending had a different, less generous, more unpleasant connotation. Even the recent talk of attending a pathology meeting in Miami during the next month made her feel uneasy.

Lowering her hands Angela stared ahead. She wondered if she was overreacting. Maybe she was blowing this episode way out of proportion, getting herself all worked up. After all, David was forever accusing her of being overly dramatic. Maybe Wadley hadn’t been aware. Maybe he’d been so engrossed in his didactic role, he didn’t realize what he was doing.

She angrily shook her head. Deep down she knew she wasn’t overreacting. She was still grateful for Wadley’s time and effort, but she could not forget how it felt to have his hand on her thigh. It was so inappropriate. He had to have known. It had to have been deliberate. The question was what she could do to put an end to his unwanted familiarity. After all, he was her boss.

At the end of his office hours, David walked over to the central hospital building to check on Marjorie Kleber and a few other patients. Once he determined that all were doing well, he stopped by to see Nikki.

His daughter was feeling fine thanks to a judicious combination of antibiotics, mucolytic agents, bronchodilators, hydration, and physical therapy. She was leaning back against a pile of pillows with a TV remote in her hand. She was watching a game show, a pastime frowned upon at home.

“Well, well,” David said. “If it isn’t a true woman of leisure.”

“Come on, Dad,” Nikki said. “I haven’t watched much TV. Mrs. Kleber came to my room, and I even had to do some school-work.”

“That’s terrible,” David said with improvised dismay. “How’s the breathing?”

After so many sojourns in the hospital, Nikki was truly experienced at assessing her condition. Pediatricians had learned to listen to her evaluations.

“Good,” Nikki said. “It’s still a little tight, but it’s definitely better.”

Angela appeared at the doorway. “Looks like I’m just in time for a family reunion,” she said. She came in and gave both Nikki and David a hug. With Angela sitting on one side of the bed and David on the other, they talked with Nikki for half an hour.

“I want to go home,” Nikki whined when David and Angela got up to go.

“I’m sure you do,” Angela said. “And we want you home, but we have to follow Dr. Pilsner’s orders. We’ll talk to him in the morning.”

After waving goodbye and watching her parents disappear down the hall, Nikki wiped a tear from the corner of her eye and reached for the TV remote. She was accustomed to being in the hospital, but she still didn’t like it. The only good thing about it was that she could watch as much TV as she wanted and any type of programming—something she definitely couldn’t get away with at home.

David and Angela didn’t talk until they were outside under the awning covering the hospital’s rear entrance. Even then the conversation was minimal. David merely said that it was silly for both of them to get wet and then ran to get the car.

On the way home there was no conversation. The only noise was the repetitive and lugubrious sound of the windshield wipers. David and Angela both thought the other was responding to a combination of Nikki’s hospitalization, the disappointing weekend, and the incessant rain.

As if to confirm David’s suspicions Angela broke the silence as they pulled into their driveway by telling David that a preliminary look at Nikki’s sputum culture suggested pseudomonas aeruginosa. “That’s not a good sign,” Angela continued. “When that type of bacteria gets established in someone with cystic fibrosis it usually stays.”

“You don’t have to tell me,” David said.

Dinner was a stifled affair without Nikki’s presence. They ate at the kitchen table as the rain pelted the windows. Finally, after they’d finished eating, Angela found the emotional strength and the words to describe what had happened between herself and Wadley.

David’s mouth had slowly opened as the story unfolded. By the time Angela was finished his mouth was gaping in astonishment. “That bastard!” David said. He slammed his palm down onto the table and angrily shook his head. “There were a couple of times it passed through my mind he was acting a bit too enamored, like the day at the hospital picnic. But then I convinced myself I was being ridiculously jealous. But it sounds like my intuition was right.”

“I don’t know for sure,” Angela said. “Which is partly why I hesitated to tell you. I don’t want us to jump to conclusions. It’s confusing as much as it is aggravating. It’s so unfair that we women have to deal with this kind of problem.”

“It’s an old problem,” David said. “Sexual harassment has been around forever, especially since women joined the work force. It’s been part of medicine for a long time, especially back when all doctors were men and all nurses were women.”

“And it’s still around despite the rapid increase in the number of women physicians,” Angela said. “You remember some of the bullcrap I had to put up with from some of the medical school instructors.”

David nodded. “I’m sorry this has happened,” he said. “I know how pleased you’d been with Dr. Wadley. If you’d like I’ll get in the car, drive over to his house, and punch him in the nose.”

Angela smiled. “Thanks for the support.”

“I thought you were being quiet tonight because you were worried about Nikki,” David said. “Either that or angry about the weekend.”

“The weekend is history,” Angela said. “And Nikki is doing fine.”

“I had a bad day too,” David finally admitted. He got himself a beer from the refrigerator, took a long drink, and then told Angela about his utilization review with Kelley and the CMV man from Burlington.

“That’s outrageous!” Angela said when David was finished. “What nerve to talk to you like that. Especially with the kind of positive response you’ve been getting from your patients.”

“Apparently that’s not a high priority,” David said despondently.

“Are you serious? Everyone knows that doctor-patient relationships are the cornerstone of good medical care.”

“Maybe that’s passe,” David said. “The current reality is determined by people like Charles Kelley. He’s part of a new army of medical bureaucrats being created by government intervention. All of a sudden economics and politics have reached the ascendancy in the medical arena. I’m afraid the major concern is the bottom line on the balance sheet, not patient care.”

Angela shook her head.

“The problem is Washington,” David said. “Every time the government gets seriously involved in medical care they seem to screw things up. They try to please everybody and end up pleasing no one. Look at Medicare and Medicaid; they’re both a mess and both have had a disastrous effect on medicine in general.”

“What are you going to do?” Angela asked.

“I don’t know,” David said. “I’ll try to compromise somehow. I guess I’ll just take it a day at a time and see what happens. What about you?”

“I don’t know either,” Angela said. “I keep hoping that I was wrong, that I’m overreacting.”

“It’s possible, I suppose,” David said gently. “After all, this is the first time you’ve felt this way. And all along Wadley’s been a touchy-feely kind of guy. Since you never said anything up to this point, maybe he doesn’t think you mind being touched.”

“What exactly are you implying?” Angela demanded sharply.

“Nothing really,” David said quickly. “I was just responding to what you said.”

“Are you saying I brought this on myself?”

David reached across the table and grasped Angela’s arm. “Hold on!” he said. “Calm down! I’m on your side. I don’t think for a second that you are to blame.”

Angela’s sudden anger abated. She realized that she was overreacting, reflecting her own uncertainties. There was the possibility that she had been unknowingly encouraging Wadley. After all, she’d wanted to please the man as any student might, especially since she felt a debt to him for all the time and effort he’d expended on her behalf.

“I’m sorry,” Angela said. “I’m just stressed out.”

“Me too,” David said. “Let’s go to bed.”

To David’s and Angela’s disappointment, it was still raining in the morning. In contrast to the gloomy weather, however, Nikki was in high spirits and doing marvelously. Even her color had returned. The sore throat, presaging an extended illness, had disappeared with the antibiotics, indicating that if it had been infectious, it had been bacterial rather than viral in origin. Thankfully there was still no fever.

“I want to go home,” Nikki repeated.

“We haven’t talked with Dr. Pilsner,” David reminded her. “But we will, sometime this morning. Be patient.”

After the visit with Nikki, Angela left for the lab while David went to the nurses’ station to pick up Marjorie’s chart. He’d been considering discharging her until he walked into her room. Her response to his greeting told him something was wrong.

“Marjorie, what’s the matter?” David asked as he felt his own pulse quicken. She was lethargic. He touched the back of his hand to her forehead and her arms. Her skin was warm to the touch. He guessed she had a fever.

Marjorie responded to David’s persistent questioning with barely intelligible mumbling. She acted drugged although not in any apparent pain.

Noticing Marjorie’s breathing was mildly labored, David listened carefully to her chest. He heard faint sounds of congestion. Next he checked the area of phlebitis and found it was all but resolved. With mounting anxiety David examined the rest of his patient. Finding nothing he hurried back to the nurses’ station and ordered a barrage of stat laboratory tests.

The first thing to come back from the lab was her blood count, but it only added to David’s puzzlement. Her white cell level, which had been appropriately falling with the resolution of the phlebitis, had continued to fall and was now in the lower percentile of normal.

David scratched his head. The low white count seemed contradictory to her clinical state, which suggested developing pneumonia. Getting up from the desk, David went back to Marjorie’s room and listened to her chest again. The incipient congestion was real.

Returning to the nurses’ station, David debated what to do. More lab tests came back, but they were all normal, even the portable chest X ray, and hence no help. David thought about calling in some consults, but after his poor utilization review the day before, he was reluctant. The problem was that the consults who might have been helpful were not part of the CMV organization.

Instead of requesting any consults, David took the Physicians’ Desk Reference off the bookshelf. Since his main concern was that a gram-negative bacteria might have appeared as a super-infection, he looked up an antibiotic that was specific for such an eventuality. When he found one he felt confident it would take care of the problem.

After the appropriate orders were written, including a request to be called immediately if there was any change in Marjorie’s status, David headed over to his office.

It was Angela’s turn to handle the day’s surgical frozen sections. She always found the task nerve-wracking since she knew that while she worked, the patient remained under anesthesia awaiting her verdict whether the biopsy was cancerous or benign.

The frozen sections were done in a small lab within the operating suite. The room was tucked off to the side and visited infrequently by the operating room staff. Angela worked with intense concentration, studying the patterns of cells in the specimen under the microscope.

She did not hear the door silently open behind her. She was unaware that anyone was in the room until he spoke.

“Well, honey, how’s it going?”

Startled, Angela’s head shot up as a bolus of adrenaline coursed through her body. With her pulse pounding in her temples, she found herself looking into Wadley’s smiling face. She hated to be called “honey” by anyone, except maybe David. And she didn’t appreciate being snuck up on.

“Any problems?” Wadley asked.

“No,” Angela said sharply.

“Let me take a look,” Wadley said, motioning toward the microscope. “What’s the case?”

Angela gave Wadley her seat. Succinctly she gave the history. He glanced at the slide, then stood up.

For a moment they talked about the slide in pathological jargon. It was apparent they agreed the growth was benign, happy news for the anesthetized patient.

“I want to see you later in my office,” Wadley said. He winked.

Angela nodded, ignoring the wink. She turned away and was about to sit down again when she felt Wadley’s hand brush across her buttocks.

“Don’t work too hard, honey!” he called out. And with that, he slipped out the door.

The episode had happened so fast that Angela had not been able to respond. But she knew it had not been inadvertent, and now she knew for certain that the thigh-touching the day before had not been an innocent oversight.

For a few minutes Angela sat in the tiny lab and trembled with indignation and confusion. She wondered what was encouraging this sudden boldness. She certainly had not changed her behavior over the last few days. And what should she do? She couldn’t just idly sit by and allow it to go on. That would be an open invitation.

Angela decided she had two possibilities. She could confront Wadley directly or she could go to the medical director, Michael Caldwell. But then she thought about Dr. Cantor, the current chief of staff. Maybe she should go to him.

Angela sighed. Neither Caldwell nor Cantor struck her as ideal authorities to turn to in a case of sexual harassment. Both were macho types, and Angela remembered their responses when she’d first met them. Caldwell had seemed shocked that women were actually pathologists while Cantor had offered that ignorant remark about the few women in his medical school class being “dogs.”

She thought again about confronting Wadley herself, but she didn’t like that alternative any better.

The raucous buzz of static coming over the intercom shocked Angela back to reality. The static preceded the voice of the head nurse. “Dr. Wilson,” she said. “They are waiting on the biopsy results down in OR three.”

David found concentrating on his patients’ problems harder that morning than the previous afternoon. Not only was he still upset about his review with Kelley, now he had Marjorie Kleber’s worsening condition to worry about.

Midmorning, David saw another of his frequent visitors, John Tarlow, the leukemia patient. John didn’t have an appointment; David had Susan squeeze him in as a semi-emergency after he’d called that morning. Only the day before David would have directed John to the ER, but feeling chastened by Kelley’s lecture, he felt obliged to see the man himself.

John was feeling poorly. Following a meal of raw shellfish the night before, he’d developed severe GI problems with both vomiting and diarrhea. He was dehydrated and in acute discomfort with colicky abdominal pain.

Seeing how bad John was and remembering his leukemic history, David hospitalized him immediately. He ordered a number of tests to try to determine the cause of John’s symptoms. He also started intravenous fluid to rehydrate him. For the moment he held off on antibiotics, preferring to wait until he had some idea of what he was dealing with. It could have been a bacterial infection or it could have been merely a response to toxins: food poisoning, in the vernacular.

Just before eleven in the morning Traynor was told the bad news by his secretary, Collette. She’d just been informed by phone that Jeb Wiggins had again carried the Board of Selectmen. The final vote on the hospital parking garage, which Traynor had managed once more to get on the agenda, had been thumbs down. Now there probably wasn’t even a way to get it on the ballot again before spring.

“Goddamn it,” Traynor raged. He pummeled the surface of his desk with both hands. Collette didn’t flinch. She was accustomed to Traynor’s outbursts. “I’d love to grab Wiggins around that fat neck of his and choke him until he turns blue.”

Collette discreetly left the room. Traynor paced the area in front of his desk. The lack of support he had to deal with when it came to running the hospital galled him. He could not understand how the Board of Selectmen could be so shortsighted. It was obvious that the hospital was the most important enterprise in the entire town. It was equally obvious that the hospital needed the parking garage.

Unable to work, Traynor grabbed his raincoat, hat, and umbrella and stormed out of his office. Climbing into his car he drove up to the hospital. If there was to be no parking garage, he would at least personally inspect the lighting. He didn’t want to risk any more rapes in the hospital parking lot.

Traynor found Werner Van Slyke in his windowless cubbyhole that served as the engineering/maintenance department’s office. Traynor had never been particularly comfortable around Van Slyke. Van Slyke was too quiet, too much of a loner, and mildly unkempt. Traynor also found Van Slyke physically intimidating; he was several inches taller than Traynor and significantly huskier, with the kind of bulky muscles that suggested weightlifting was a hobby.

“I want to see the lights in the parking lots,” Traynor said.

“Now?” Van Slyke asked, without the usual rise in the pitch of his voice that normal people use when asking questions. Every word he said was flat and it grated on Traynor’s ears.

“I had a little free time,” Traynor explained. “I want to make sure it’s adequate.”

Van Slyke pulled on a yellow slicker and walked out of the office. Outside the hospital he pointed to each of the lights in the lower lot, walking from one to the next without comment.

Traynor tagged along beneath his umbrella, nodding at each fixture. As he followed Van Slyke through the copse of evergreen trees and climbed the wooden steps that separated the two lots, Traynor wondered what Van Slyke did when he wasn’t working. He realized he never saw Van Slyke walking around the town or shopping in the shops. And the man was notorious for not attending hospital functions.

Uncomfortable with the continued silence, Traynor cleared his throat: “Everything okay at home?” he asked.

“Fine,” Van Slyke said.

“House okay, no problems?”

“Nope,” Van Slyke said.

Traynor started feeling challenged to get Van Slyke to respond with more than monosyllables. “Do you like civilian life better than the navy?”

Van Slyke shrugged and began pointing out the lights in the upper lot. Traynor continued to nod at each one. There seemed to be plenty. Traynor made a mental note to swing up there with his car some evening to see how light it was after dark.

“Looks good,” Traynor said.

They started back toward the hospital.

“You being careful with your money?” Traynor asked.

“Yeah,” Van Slyke said.

“I think you are doing a great job here at the hospital,” Traynor said. “I’m proud of you.”

Van Slyke didn’t respond. Traynor looked over at Van Slyke’s wet profile with its heavy five o’clock shadow. He wondered how Van Slyke could be so unemotional, but then again he realized that he’d never understood the boy ever since he’d been little. Sometimes Traynor found it hard to believe they were related, yet they were. Van Slyke was Traynor’s only nephew, the son of his deceased sister.

When they reached the stand of trees separating the two lots, Traynor stopped. He looked among the branches. “How come there are no lights on this path?”

“No one said anything about lights on the path,” Van Slyke said. It was the first full sentence he had uttered. Traynor was almost pleased.

“I think one or two would be nice,” Traynor said.

Van Slyke barely nodded.

“Thanks for the tour,” Traynor said in parting. He was relieved to make his escape. He had always felt guilty for feeling so estranged from his own kin, but Van Slyke was such an enigma. Traynor had to admit that his sister hadn’t exactly been a paragon of normality. Her name had been Sunny, but her disposition had been anything but. She’d always been quiet, retiring, and had suffered from depression for most of her life.

Traynor still had a hard time understanding why Sunny had married Dr. Werner Van Slyke, knowing the man was a drunk. Her suicide was the final blow. If she’d only come to him, he would have tried to help.

In any case, given Werner Van Slyke’s parentage, it was hardly a surprise that he was as strange as he was. Yet with his naval machinist’s training he’d been both helpful and reliable. Traynor was glad he’d suggested that the hospital hire him.

Traynor roused himself from this reflection and headed for Beaton’s office.

“I’ve got some bad news,” Traynor said as soon as Beaton’s secretary admitted him. He told her about the Board of Selectmen’s vote on the parking garage.

“I hope we don’t have any more assaults,” Beaton said. She was clearly disappointed.

“Me too,” Traynor said. “Hopefully the lights will be a deterrent. I just walked around the parking lots and took a look at them. They seem adequate enough, except on the path between the two lots. I asked Van Slyke to add a couple there.”

“I’m sorry I didn’t do both lots from the start,” Beaton said.

“How are the finances looking for this month?” Traynor questioned.

“I was afraid you’d ask,” Beaton said. “Arnsworth gave me the mid-month figures just yesterday and they are not good. October will definitely be worse than September if the second half of the month is anything like the first. The bonus program is helping, but admissions for CMV are still over the projected level. To make matters worse, we seem to be getting sicker patients.”

“I suppose that means we have to put more pressure on utilization,” Traynor said. “DUC has to save the day. Other than the bonus program, we’re on our own. I don’t anticipate any more insurance bequests in the near future.”

“There are a few other nuisances of which you should be aware,” Beaton said. “M.D. 91 has relapsed. Robertson picked him up on a DUI. He was driving his car on the sidewalk.”

“Pull his privileges,” Traynor said without hesitation. “Alcoholic physicians have already caused enough heartache in my life.” He recalled once again his sister’s good-for-nothing husband.

“The other problem,” Beaton said, “is that Sophie Stephangelos, the head nurse in the OR, has discovered significant theft of surgical instruments over the last year. She thinks one of the surgeons is taking them.”

“What next?” Traynor said with a sigh. “Sometimes I think running a hospital is an impossible task.”

“She has a plan to catch the culprit,” Beaton said. “She wants an okay to go ahead with it.”

“By all means,” Traynor said. “And if she catches him let’s make an example out of him.”

Coming out of one of his examining rooms, David was surprised to find that the basket on the other room’s door was empty.

“No charts?” he asked.

“You’re ahead of yourself,” Susan explained. “Take a break.”

David took advantage of the opportunity to dash over to the hospital. The first stop was Nikki’s room. When he walked in he was surprised to find both Caroline and Arni sitting on Nikki’s bed. Somehow the two kids had managed to get into the hospital without being challenged. They were supposed to be accompanied by an adult.

“You won’t get us into trouble, will you, Dr. Wilson?” Caroline asked. She looked much younger than nine. Her illness had stunted her growth much more than it had Nikki’s. She looked more like a child of seven or eight.

“No, I won’t get you in trouble,” David assured them. “But how did you get out of school so early?”

“It was easy for me,” Arni said proudly. “The substitute teacher doesn’t know what’s going on. She’s a mess.”

David turned his attention to his daughter. “I spoke with Dr. Pilsner, and he said it’s okay for you to go home this afternoon.”

“Cool,” Nikki said excitedly. “Can I go to school tomorrow?”

“I don’t know about that,” David said. “We’ll have to discuss it with your mother.”

After leaving Nikki’s room, David looked in on John Tarlow to make sure that he was settled, his IV was started, and the tests David had ordered were in progress. John said he didn’t feel any better. David told him to be patient and assured him there’d be improvement after he’d been hydrated.

Finally David stopped in to see Marjorie. He hoped that the added antibiotic would have already improved her condition, but it hadn’t. In fact, David was shocked to see how much she had deteriorated; she was practically comatose.

Panic-stricken, David listened to Marjorie’s chest. There was more congestion than earlier but still not enough to explain her clinical state. Rushing back to the nurses’ station, David demanded to know why he hadn’t been called.

“Called on what?” Janet Colburn asked. She was the head nurse.

“Marjorie Kleber,” David yelled while he wrote orders for more stat bloodwork and another portable chest X ray.

Janet consulted with several of the other floor nurses, then told David that no one had noticed any change. She even said that one of the LPNs had just been in Marjorie’s room less than half an hour previously and had reported no change.

“That’s impossible,” David snapped as he grabbed the phone and started making calls. Earlier, he’d been reluctant to call in consults. Now he was panicked to get them to come in as soon as possible. He called Marjorie’s oncologist, Dr. Clark Mieslich, and an infectious disease specialist, Dr. Martin Hasselbaum. Neither of them were CMV doctors. David also called a neurologist named Alan Prichard, who was part of the CMV organization.

All three specialists were available for David’s call. When they heard David’s frantic appeal and his description of the case, they all agreed to come in immediately. David then called Susan to alert her to what was happening. He told her to advise the patients who came into the office that he would be delayed.

The oncologist was the first to arrive, followed in short order by the infectious disease specialist and the neurologist. They reviewed the chart and discussed the situation with David, before descending en masse on Marjorie. After examining her closely they withdrew to the nurses’ station to confer. But hardly had they begun to discuss Marjorie’s condition when disaster struck.

“She’s stopped breathing,” a nurse yelled from Marjorie’s room. She’d stayed behind to clean up the debris left by the examining specialists.

While David and the consults raced back, Janet Colburn called the resuscitation team. They arrived in minutes and converged on room 204.

With so much manpower immediately available, Marjorie was quickly intubated and respired. It had been done with such dispatch that her heart rate did not change. Everyone was confident she’d experienced only a short period of decreased oxygen. The problem was they did not know why she’d stopped breathing.

As they began to discuss possible causes, her heart suddenly slowed and then stopped. The monitor displayed an eerie flat line. The resuscitation team shocked her in hopes of restarting her heart, but there was no response. They quickly shocked her again. When that didn’t work, they began closed chest cardiac massage.

They worked frenetically for thirty minutes, trying every trick they could think of, but nothing worked. The heart would not even respond to external pacing. Gradually, discouragement set in, and finally, by general consensus, Marjorie Kleber was declared dead.

While the resuscitation team unhooked their wires and the nurses cleaned up, David walked back to the nurses’ station with the consults. He was devastated. He could not imagine a worse scenario. Marjorie had come into the hospital with a relatively minor problem while he was off enjoying himself. Now she was dead.

“It’s too bad,” Dr. Mieslich said. “She was such a terrific person.”

“I’d say she did pretty well considering the history in the chart,” Dr. Prichard said. “But her disease was bound to catch up with her.”

“Wait a second,” David said. “Do you think she died of her cancer?”

“Obviously,” Dr. Mieslich said. “She had disseminated cancer when I first saw her. Although she’d done better than I would have predicted, she was one sick lady.”

“But there wasn’t any clinical evidence of her tumor,” David said. “Her problems leading up to this fatal episode seemed to suggest some sort of immune system malfunction. How can you relate that to her cancer?”

“The immune system doesn’t control breathing or the heart,” Dr. Prichard said.

“But her white count was falling,” David said.

“Her tumor wasn’t apparent, that’s true,” Dr. Mieslich said. “But if we were to open her up, my guess is that we would find cancer all over, including in her brain. Remember, she had extensive metastases when she was originally diagnosed.”

David nodded. The others did the same. Dr. Prichard slapped David on the back. “Can’t win them all,” he said.

David thanked the consults for coming in. They all politely thanked him for the referral, then went their separate ways. David sat at the nurses’ station desk. He felt weak and disconsolate. His sadness and sense of guilt at Marjorie’s passing was even more acute than he’d feared. He’d come to know her too well. To make it even worse, she was Nikki’s beloved teacher. How would he explain this to her?

“Excuse me,” Janet Colburn said softly. “Lloyd Kleber, Marjorie’s husband, is here. He’d like to talk to you.”

David stood up. He felt numb. He didn’t know how long he’d been sitting at the nurses’ station. Janet directed him into the patients’ lounge.

Lloyd Kleber was staring out the window at the rain. David guessed he was in his mid-forties. His eyes were red from crying. David’s heart went out to the man. Not only had he lost a wife, but now he had the responsibility of two motherless children.

“I’m sorry,” David said lamely.

“Thank you,” Lloyd said, choking back tears. “And thank you for taking care of Marjorie. She really appreciated your concern for her.”

David nodded. He tried to say things that reflected his compassion. He never felt adequate at moments like this, but he did the best he could.

Finally, David ventured to ask for permission to do an autopsy. He knew it was a lot to ask, but he was deeply troubled by Marjorie’s swift deterioration. He wanted desperately to understand.

“If it could help others in some small way,” Mr. Kleber said, “I’m sure Marjorie would want it done.”

David stayed and talked with Lloyd Kleber until more members of the immediate family arrived. Then David, leaving them to their grief, walked over to the lab. He found Angela at the desk in her office. She was pleased to see him and told him so. Then she noticed his strained expression.

“What’s wrong?” she asked anxiously. She stood up and took his hand.

David told her. He had to stop a few times to compose himself.

“I’m so sorry,” Angela said. She put her arms around him and gave him a reassuring hug.

“Some doctor!” he chided himself, fighting tears. “You’d think I’d have adjusted better to this kind of thing by now.”

“Your sensitivity is part of your charm,” Angela assured him. “It’s also what makes you a good doctor.”

“Mr. Kleber agreed to an autopsy,” David said. “I’m glad because I haven’t the slightest idea why she died, especially so quickly. Her breathing stopped and then her heart. The consults all think it was her cancer. It probably was. But I’d like Bartlet to confirm it. Could you see that it gets done?”

“Sure,” Angela said. “But please don’t get too depressed over this. It wasn’t your fault.”

“Let’s see what the autopsy shows,” David said. “And what am I going to tell Nikki?”

“That’s going to be hard,” Angela admitted.

David returned to his office to try to see his patients in as short order as possible. For their sake, he hated being so backed up, but there had been no way to avoid it. He’d only managed to see four when Susan waylaid him between examining rooms.

“Sorry to bother you,” she said, “but Charles Kelley is in your private office, and he demands to see you immediately.”

Fearing Kelley’s visit had something to do with Marjorie’s death, David stepped across the hall into his office. Kelley was impatiently pacing. He stopped when David arrived. David closed the door behind himself.

Kelley’s face was hard and angry. “I find your behavior particularly galling,” he said, towering over David.

“What are you talking about?” David asked.

“Just yesterday I spoke with you about utilization,” Kelley said. “I thought it was pretty clear and that you understood. Then today you irresponsibly ordered two non-CMV consults to see a hopelessly terminal patient. That kind of behavior suggests that you have no comprehension of the major problem facing medicine today: unnecessary and wasteful expense.”

With his emotions raw, David struggled to keep himself under control. “Just a minute. I’d like you to tell me how you know the consults were unnecessary.”

“Oh, brother!” Kelley said with a supercilious wave of his head. “It’s obvious. The patient’s course wasn’t altered. She was dying and she proceeded to die. Everyone must die at some time or another. Money and other resources should not be thrown away for the sake of hopeless heroics.”

David stared into Kelley’s blue eyes. He didn’t know what to say. He was dumbfounded.

Hoping to avoid Wadley, Angela sought out Dr. Paul Darnell in his windowless cubicle on the other side of the lab. His desk was piled high with bacterial culture dishes. Microbiology was his particular area of interest.

“Can I speak to you for a moment,” Angela called from Paul’s doorway.

He waved her in and leaned back in his swivel chair.

“What’s the autopsy protocol around here?” she asked. “I haven’t seen any done since I got here.”

“That’s an issue you’ll have to discuss with Wadley,” Paul said. “It’s a policy problem. Sorry.”

Reluctantly, Angela went to Wadley’s office.

“What can I do for you, honey?” Wadley said. He smiled a kind of smile Angela had previously seen as paternal but now saw as lewd.

Wincing at being addressed as “honey,” Angela swallowed her pride and asked about the procedure for arranging an autopsy.

“We don’t do autopsies,” Wadley said. “If it’s a medical examiner case, the body goes to Burlington. It costs too much to do autopsies, and the contract with CMV doesn’t include them.”

“What if the family requests it?” Angela asked, knowing this wasn’t precisely true in the Kleber case.

“If they want to shell out eighteen hundred and ninety dollars, then we’ll accommodate them,” Wadley said. “Otherwise, we don’t do it.”

Angela nodded, then left. Instead of getting back to her own work, she walked over to the professional building and went into David’s office. She was appalled by the number of patients waiting to be seen. Every chair in the waiting room was occupied; a few people were even standing in the hall. She caught David as he shuttled between examining rooms. He was clearly frazzled.

“I can’t do an autopsy on Marjorie Kleber.”

“Why not?” David asked.

Angela told him what Wadley had said.

David shook his head with frustration and blew out between pursed lips. “My opinion of this place is going downhill fast,” he said. He then told Angela about Kelley’s opinion of his handling of the Kleber case.

“That’s ridiculous,” Angela said. She was incensed. “You mean he suggested that the consults were unnecessary because the patient died. That’s crazy.”

“What can I tell you?” David said with a shake of his head.

Angela didn’t know what to say. Kelley was beginning to sound dangerously uninformed. Angela would have liked to talk more, but she knew David didn’t have the time. She motioned over her shoulder. “You’ve got an office full of patients out there,” she said. “When do you think you’ll be done?”

“I haven’t the slightest idea.”

“How about I take Nikki home and you give me a call when you’re ready to leave. I’ll come back and pick you up.”

“Sounds good,” David said.

“Hang in there, dear,” Angela said. “We’ll talk later.”

Angela went back to the lab, finishing up for the day, collected Nikki, and drove home. Nikki was ecstatic to get out of the hospital. She and Rusty had an exuberant reunion.

David called at seven-fifteen. With Nikki comfortably ensconced in front of the TV, Angela returned to the hospital. She drove slowly. It was raining so hard the wipers had to struggle to keep the windshield clear.

“What a night,” David said as he jumped into the car.

“What a day,” Angela said as she started down the hill toward town. “Especially for you. How are you holding up?”

“I’m managing,” David said. “It was a help to be so busy. I was grateful for the diversion. But now I have to face reality; what am I going to tell Nikki?”

“You’ll just have to tell her the truth,” Angela said.

“That’s easier said than done,” David said. “What if she asks me why she died? The trouble is I don’t know, neither physiologically nor metaphysically.”

“I’ve thought more about what Kelley said,” Angela said. “It seems to me he has a fundamental misunderstanding about the basics of patient care.”

“That’s an understatement,” David said with a short, sarcastic laugh. “The scary part is that he’s in a supervisory position. Bureaucrats like Kelley are intruding into the practice of medicine under the guise of health-care reform. Unfortunately the public has no idea.”

“I had another minor run-in with Wadley today,” Angela said.

“That bastard!” David said. “What did he do now?”

“He called me ‘honey’ a few times,” Angela said. “And he brushed his hand across my backside.”

“God! What an insensitive jerk,” David said.

“I really have to do something. I just wish I knew what.”

“I think you should talk to Cantor,” David said. “I’ve given it some thought. At least Cantor is a physician, not just a health-care bureaucrat.”

“His comment about ‘the girls,’ as he called them, in his medical school class was not inspiring,” Angela said.

They pulled into their driveway. Angela came to a stop as close as possible to the door to the mud room. They both prepared to run for shelter.

“When is this rain going to stop?” David complained. “It’s been raining for three days straight.”

Once they were inside, David decided to make a fire to cheer up the house while Angela reheated the food she’d made earlier for herself and Nikki. Descending into the basement, David noticed that moisture was seeping through the grout between the granite foundation blocks. Along with the moisture was the damp, musty odor he’d occasionally smelled before. As he collected the wood, he comforted himself with the thought of the earthen floor. If a significant amount of water were to come into the basement, it would just soak in and eventually disappear.

After eating, David joined Nikki in front of the TV. Whenever she was ill they were lenient about how much time she was allowed to watch. David feigned interest in the show in progress, while he built up the courage to tell Nikki about Marjorie. Finally, during a commercial break, David put his arm around his daughter.

“I have to tell you something,” he said gently.

“What?” Nikki asked. She was contentedly petting Rusty who was curled up on the couch next to her.

“Your teacher, Marjorie Kleber, died today,” David said gently.

Nikki didn’t say anything for a few moments. She looked down at Rusty, pretending to be concerned about a knot behind his ear.

“It makes me very sad,” David continued, “especially since I was her doctor. I’m sure it upsets you, too.”

“No, it doesn’t,” Nikki said quickly with a shake of her head. She brushed a strand of hair away from her eyes. Then she looked at the television as if she were interested in the commercial.

“It’s okay to be sad,” David said. He started to talk about missing people you cared about when Nikki suddenly threw herself at him, enveloping him in a flood of tears. She hugged him tighter than he could ever remember her having hugged him.

David patted her on the back and continued to reassure her.

Angela appeared at the doorway. Seeing David holding their sobbing child, she came over. Gently pushing Rusty aside, she sat down and put her arms around both David and Nikki. Together the three held onto each other, rocking gently as the rain beat against the windows.

Despite Nikki’s sustained protests, David and Angela insisted that she stay home from school another day. Considering the weather and the fact that she was still on antibiotics there was no reason to take a chance.

Although Nikki was not as cooperative as usual, they carried out her morning respiratory therapy with great diligence. Both David and Angela listened to her chest afterward and both were satisfied.

Alice Doherty arrived exactly at the time she promised. David and Angela were thankful to have someone so reliable and so conveniently available.

As Angela and David climbed into their blue Volvo, David complained that he’d not been able to ride his bike all week. It wasn’t raining as hard as it had been, but the clouds were low and ponderous, and a heavy mist rose out of the saturated earth.

They got to the hospital at seven-thirty. While Angela headed off for the lab, David went up to the patient floor. When he entered John Tarlow’s room he was surprised to find drop cloths, stepladders, and an empty bed. Continuing on to the nurses’ station he inquired after his patient.

“Mr. Tarlow has been moved to 206,” Janet Colburn said.

“How come?” David asked.

“They wanted to paint the room,” Janet said. “Maintenance came up and informed us. We let admitting know, and they told us to transfer the patient to 206.”

“I think that’s inconsiderate,” David complained.

“Well, don’t blame us,” Janet said. “Talk to maintenance.”

Feeling irritated for his patient’s sake, David took Janet’s suggestion and marched down to maintenance. He knocked on the jamb of the maintenance/engineering office. Inside and bent over a desk was a man close to David’s age. He was dressed in rumpled, medium-green cotton twill work shirt and pants. His face was textured with a two-day growth of whiskers.

“What?” Van Slyke asked as he looked up from his scheduling book. His voice was flat and his expression was emotionless.

“One of my patients was moved from his room,” David said. “I want to know why.”

“If you are talking about room 216, it’s being painted,” Van Slyke said in a monotone.

“It’s obvious it’s being painted,” David said. “What isn’t obvious is why it’s being painted.”

“We have a schedule,” Van Slyke said.

“Schedule or no schedule,” David said, “I hardly think patients should be inconvenienced, especially patients who are ill, and patients in the hospital are invariably ill.”

“Talk to Beaton if you have a problem,” Van Slyke said. He went back to his book.

Taken aback by Van Slyke’s insolence, David stood stunned in the doorway for a moment. Van Slyke ignored him with ease. David shook his head, then turned to go. On his way back to the patient floor, he was seriously considering taking Van Slyke’s advice to discuss the situation with the hospital administrator until he walked into John Tarlow’s new room. Suddenly David was presented with a more pressing problem: John Tarlow’s condition was worse.

John’s diarrhea and vomiting, which initially had been controlled, had returned with a vengeance. On top of that, John was obtunded, and when aroused, apathetic. David could not understand these symptoms since John had been on IVs since his admission and was clearly not dehydrated.

David examined his patient carefully but couldn’t find an explanation for the marked change in his clinical state, particularly his depressed mental status. The only thing David could think of was the possibility John could have been overly sensitive to the sleeping medication that David had prescribed as a PRN order, meaning it was to be given if the patient requested it.

Hurrying back to the nurses’ station, David pulled John’s chart from the rack. He desperately pored over the data that had returned overnight from the lab in an attempt to understand what was going on and to try to decide what to do next. As a result of the run-in with Kelley the day before he was reluctant to request any consults since neither of the two he wanted—oncology and infectious disease—were CMV doctors.

David closed his eyes and rubbed his temples. He did not feel he was making much progress. Unfortunately, a key piece of information was lacking: the results of the stool cultures plated the day before were not yet available. Consequently David still didn’t know if he was dealing with a bacteria or not, and if he was, what kind of bacteria it was. On the positive side was the fact that John was still afebrile.

Redirecting his attention to the chart, David ascertained that John had been given the PRN sleeping medication. Thinking that it might have contributed to John’s lethargy, David canceled it. He also ordered another stool culture and another blood count. As a final request, he asked for John’s temperature to be taken every hour along with the express order for David to be called if it rose above normal.

After completing the last scheduled biopsy, Angela tidied up the small pathology lab in the OR suite, and headed for her office. Her morning had been productive and pleasant; she’d managed to avoid Wadley entirely. Unfortunately, she knew she’d eventually have to see him, and she worried about his behavior. Although she considered herself an optimistic person, she was fearful that the problem with Wadley would not spontaneously resolve.

Entering the office, Angela immediately noticed the connecting door from her office into Wadley’s was ajar. As silently as possible she moved over to the door and began to close it.

“Angela!” Wadley called out, making Angela flinch. She hadn’t realized how tense she was. “Come in here. I want to show you something fascinating.”

Angela sighed and reluctantly opened the door. Wadley was sitting at his desk in front of his regular microscope, not the teaching microscope.

“Come on,” Wadley called again. He waved Angela over and tapped the top of his microscope. “Take a gander at this slide.”

Warily Angela advanced into the room. Several feet away she hesitated. As if sensing her reluctance, Wadley gave himself a little push, and his chair rolled back from the desk. Angela stepped up to the microscope and leaned over to adjust the eyepieces.

Before she could look in Wadley lunged forward and grabbed her around the waist. He pulled her onto his lap and locked his arms around her.

“Gotcha!” Wadley cried.

Angela shrieked and struggled to get away. The unexpected forcefulness of the contact shocked her. She’d been concerned about him touching her subtly, not manhandling her.

“Let me go!” Angela demanded angrily, trying to unlock his fingers and break his grip.

“Not until you let me tell you something,” Wadley said. He was chuckling.

Angela stopped struggling. She had her eyes closed. She was as humiliated as she was furious.

“That’s better,” Wadley said. “I’ve got good news. The trip is all set. I even got the tickets already. We’re going to the pathology meeting in Miami in November.”

Angela opened her eyes. “Wonderful,” she said with as much sarcasm as she could muster. “Now let me go!”

Wadley released her and Angela sprang from his lap. But as she pulled away he managed to grab her wrist. “It’s going to be fantastic,” Wadley said. “The weather will be perfect. It’s the best time of year in Miami. We’ll be staying on the beach. I got us rooms in the Fontainbleau.”

“Let go!” Angela demanded through clenched teeth.

“Hey,” Wadley said. He leaned forward and looked at her closely. “Are you mad or something? I’m sorry if I scared you. I just wanted it to be a surprise.” He let go of her hand.

Angela was beside herself with anger. Biting her tongue to keep herself from exploding, she dashed into her office. Mortified and demeaned, she slammed the connecting door.

Forcibly she rubbed her face with both hands, trying to regain a modicum of control. She was shaking from the adrenaline coursing through her body. It took her a few minutes to settle down and for her breathing to return to normal. Once it had, she grabbed her coat, and angrily stalked out of her office. At least Wadley’s oafishly inappropriate advances had finally spurred her to action.

Avoiding the misty rain as much as possible, she dashed from the main hospital building to the Imaging Center. Once under the projecting eaves she slowed to a fast walk. Inside she went directly to Cantor’s office.

Not having called beforehand, Angela had to wait almost a half hour before Dr. Delbert Cantor could see her. While she waited she calmed down considerably and even began once more to question if she were partly to blame for Wadley’s behavior. She wondered if she should have anticipated it and not have been so naive.

“Come in, come in,” Cantor said agreeably when he could finally see her. He’d gotten up from his disordered desk to escort Angela into the room. He had to move a stack of unopened radiology journals from a chair for her to sit down. He offered her some refreshment. She politely refused. He sat down, crossed his legs and arms, and asked what he could possibly do for her.

Now that she was face to face with the chief of the professional staff, Angela was not encouraged. All her misgivings about the man and his attitude toward women came back in a rush. His face had assumed a smirk as if he had already decided that whatever was on her female mind was of little consequence.

“This is not easy for me,” Angela began. “So please bear with me. It was hard for me to come here, but I don’t know what else to do.”

Cantor encouraged her to continue.

“I’m here because I’m being sexually harassed by Dr. Wadley.”

Cantor uncrossed his legs and leaned forward. Angela was encouraged that at least he was interested, but then she noticed that the smirk had remained.

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

“Probably the whole time I’ve been here,” Angela said, intending to elaborate, but Cantor interrupted her.

“Probably?” he questioned with raised eyebrows. “You mean you’re not sure?”

“It wasn’t apparent initially,” Angela explained. “At first I just thought he was acting like a particularly enthusiastic mentor, almost parental.” She then went on to describe what had happened from the beginning; how it started as a problem of boundaries. “He always took advantage of opportunities to be close to me and touch me seemingly innocently,” Angela explained. “He also insisted on confiding in me about personal family issues that I felt were inappropriate.”

“This behavior you are describing can all be within the framework of friendship and the role of the mentor,” Cantor said.

“I agree,” Angela said. “That’s why I allowed it to go on. The problem is that it has progressed.”

“You mean it has changed?” Cantor asked.

“Most definitely,” Angela said. “Quite recently.” She then described the hand-on-the-thigh incident, feeling strangely embarrassed as she did so. She mentioned the hand brushing her backside and Wadley’s sudden use of the appellation “honey.”

“I personally don’t see anything wrong with the word ‘honey,’  ” Cantor said. “I use it all the time with my girls here in the Imaging Center.”

Angela could only stare at the man while she wondered how the women in the Center felt about his behavior. Clearly she was in the wrong place. She couldn’t begin to expect a fair hearing from a doctor whose views on women were probably more archaic than Wadley’s. Nonetheless, she figured she should finish what she started, so she described the most recent incident: Wadley’s pulling her onto his lap to announce their trip to Miami.

“I don’t know what to say about all this,” Cantor said once she finished. “Has Dr. Wadley ever implied that your job depends on sexual favors?”

Inwardly Angela groaned, fearing that Cantor’s comprehension of sexual harassment was limited to the most overt circumstances. “No,” she said. “Dr. Wadley has never intimated anything like that. But I find his unwanted familiarity extremely upsetting. It goes way beyond the bounds of friendship or a professional relationship, or even mutual respect. It makes working very difficult.”

“Maybe you’re overreacting. Wadley is just an expressive guy. You yourself said he’s enthusiastic.” When Cantor saw the look on Angela’s face he added, “Well, it’s a possibility.”

Angela stood up. She forced herself to thank him for his time.

“Not at all,” Cantor said as he pushed himself upright. “Keep me informed, young lady. Meanwhile, I promise I’ll talk with Dr. Wadley as soon as I have an opportunity.”

Angela nodded at this final offer and walked out. As she returned to her office, she couldn’t help but feel that turning to Cantor wasn’t going to help matters any. If anything, it was only going to make the situation worse.

Throughout the afternoon David had dashed over to check on John Tarlow every chance he had. Unfortunately, John hadn’t improved. At the same time he hadn’t deteriorated since David had made sure his IV’s had kept up with his fluid loss from his vomiting and diarrhea. As David entered his room late in the afternoon for his final visit of the day, he hoped he would at least find John’s mental status improved. But it wasn’t. John was as listless as he’d been that morning, perhaps even a degree more so. When pressed, John could still say his name, and he knew he was in the hospital, but as to the month or the year, he had no clue.

Back at the nurses’ station David went over the laboratory and diagnostic results that he had available, most of which were normal. The blood count done that day showed some decrease in John’s white count, but in light of John’s leukemic history, David had no idea how to interpret the drop. The preliminary stool culture which was now available was negative for pathological bacteria.

“Please call me if Mr. Tarlow’s temperature goes up or his GI symptoms get worse,” he told the nurses before he left their station.

David and Angela met in the hospital lobby. Together they ran for their car. The weather was getting worse. Not only was it still raining, it had gotten much colder.

On their way home, Angela told David about the latest incident with Wadley and Cantor’s reaction to her complaint.

David shook his head. “Wadley I give up on. He’s an ass. But I’d expected more from Cantor, especially in his position as chief of the professional staff. Even if he’s insensitive you’d think he’d be aware of the law—and the hospital’s liability. Do you think he’s slept through the last decade’s worth of legal decisions on sexual harassment?”

Angela shrugged. “I don’t want to think about it anymore. How was your day? Has Marjorie’s death been on your mind?”

“I haven’t had time to dwell on it,” David said. “I’ve got John Tarlow in the hospital and he’s scaring me.”

“What’s wrong?”

“That’s just it: I don’t know,” David said. “That’s what scares me. He’s become apathetic, much the way Marjorie was. He has a lot of functional GI complaints. That’s what brought him into the hospital, and they have gotten worse. I don’t know what’s going on, but my sixth sense is setting off alarm bells. The trouble is I don’t know what to do. At this point I’m just treating his symptoms.”

“That’s the kind of story that makes me glad I went into pathology,” Angela said.

David then told Angela about his visit to Werner Van Slyke. “The man was more than rude,” David complained. “He hardly gave me the time of day. It gives you an idea of the doctor’s position in the new hospital environment. Now the doctor is just another employee, merely working in a different department.”

“It makes it hard to be a patient advocate when even the maintenance department isn’t responsive.”

“My thoughts exactly,” David said.

When David and Angela arrived home, Nikki was happy to see them. She’d been bored for most of the day until Arni stopped over to tell her about their new teacher.

“He’s a man,” Arni told David. “And real strict.”

“I hope he’s a good teacher,” David said. He felt another stab of guilt about Marjorie’s passing.

While Angela started dinner David drove Arni home. When David returned, Nikki met him at the door with a complaint. “It feels cold in the family room,” she said.

David walked into the room and patted the radiator. It was blisteringly hot. He walked over to the French doors leading to the terrace and made sure they were closed. “Where did you feel cold?” David asked.

“Sitting on the couch,” Nikki said. “Come over and try it.”

David followed his daughter and sat down next to her. Immediately he could feel a cool draft on the back of his neck. “You’re right,” he said. He checked the windows behind the couch. “I think I’ve made the diagnosis,” he said. “We need to put up the storm windows.”

“What are storm windows?” Nikki asked.

David launched into an involved explanation of heat loss, convection currents, insulation, and Thermopane windows.

“You’re confusing her,” Angela called from the kitchen. She’d overheard a portion of the conversation. “All she asked was what a storm window was. Why don’t you show her one?”

“Good idea,” David said. “Come on. We’ll get firewood at the same time.”

“I don’t like it down here,” Nikki said as they descended the cellar stairs.

“Why not?” David asked.

“It’s scary,” Nikki protested.

“Now, don’t be like your mother,” David teased her. “One hysterical female in the house is enough.”

Leaning against the back of the granite staircase was a stack of storm windows. David moved one away from the others so Nikki could see it.

“It looks like a regular window,” Nikki said.

“But it doesn’t open,” David said. “It traps air between this glass and the glass of the existing window. That’s what serves as insulation.”

While Nikki inspected the window, David noticed something for the first time.

“What is it, Daddy?” Nikki asked, aware that her father had become distracted.

“Something I’ve never noticed before,” David said. He reached over the stack of storm windows and ran his hand over the wall that formed the back of the stairs. “These are cinder blocks.”

“What are cinder blocks?” Nikki asked.

Preoccupied with his discovery, David ignored Nikki’s question.

“Let’s move these storm windows,” David said. He lifted the window he was holding and carried it over to the foundation wall. Nikki tipped the next one upright.

“This wall is different from the rest of the basement,” David said after the last window had been moved away. “And it doesn’t appear to be that old. I wonder why it’s here.”

“What are you talking about?” Nikki asked.

David showed her that the staircase was made of granite. Then he took her back beneath the stairs and showed her the cinder blocks. He explained that they must be covering some kind of triangular storage space.

“What’s in it?” Nikki asked.

David shrugged. “I wonder.” Then he said: “Why don’t we take a peek. Maybe it’s a treasure.”

“Really?” Nikki asked.

David got the sledgehammer that was used along with a wedge to split the firewood and brought it over to the base of the stairs.

Just as David hefted the sledgehammer Angela called down the stairs to ask what mischief they were getting themselves into. David lowered the sledgehammer and put a finger to his lips. Then he shouted up to Angela that they’d be coming up with the firewood in a minute.

“I’ll be upstairs taking a shower,” Angela called down. “After that we’ll eat.”

“Okay,” David called back. Then to Nikki he said: “She might take a dim view of our busting out part of the house.”

Nikki giggled.

David waited long enough for Angela to get to the second floor before picking up the sledgehammer again. After telling Nikki to avert her eyes, David knocked out a portion of a cinder block near the top of the wall, creating a small hole.

“Run up and get a flashlight,” David said. A musty odor wafted out of the walled-off space.

While Nikki was gone, David used the sledgehammer to enlarge the hole. With a final blow a whole cinder block came loose, and David lifted it out of the wall. By then Nikki was back with the flashlight. David took it and peered in.

David’s heart jumped in his chest. He pulled his head out of the hole so quickly he skinned the back of his neck on the sharp edge of the cinder block.

“What did you see?” Nikki asked. She didn’t like the look on her father’s face.

“It’s not a treasure,” David said. “I think you’d better get your mother.”

While Nikki was gone, David enlarged the hole even more. By the time Angela came down the stairs in her bathrobe David had a whole course of the cinder blocks dismantled.

“What’s going on?” Angela demanded. “You’ve got Nikki upset.”

“Take a look,” David said. He handed Angela the flashlight and motioned for her to come see.

“This better not be a joke,” Angela said.

“It’s no joke,” David assured her.

“My God!” Angela said. Her voice echoed in the small space.

“What is it?” Nikki asked. “I want to see too.”

Angela pulled her head out and looked at David. “It’s a body,” she said. “And it’s obviously been in there for some time.”

“A person?” Nikki asked with disbelief. “Can I see?”

Angela and David both nearly shouted, “No.”

Nikki started to protest, but her voice lacked conviction.

“Let’s go upstairs and build that fire,” David said. He took Nikki over to the woodpile and handed her a log. Then he picked up an armload himself.

While Angela phoned the town police David and Nikki worked on the fire. Nikki was full of questions that David couldn’t answer.

Half an hour later a police cruiser turned into the Wilsons’ driveway and pulled up to the house.

Two policemen had responded to Angela’s call.

“My name’s Wayne Robertson,” the shorter of the pair said. He was dressed in mufti with a quilted cotton vest over a plaid flannel shirt. On his head was a Boston Red Sox baseball cap. “I’m chief of police and this is one of my deputies, Sherwin Morris.”

Sherwin touched the brim of his hat. Tall and lanky, he was dressed in uniform. He was carrying a long flashlight: the kind that took four batteries.

“Officer Morris stopped by to pick me up after you called,” Robertson explained. “I wasn’t on duty, but this sounded important.”

Angela nodded. “I appreciate your coming,” she said.

Angela and David led the way. Only Nikki remained upstairs. Robertson took the flashlight from Morris and poked his head into the hole.

“I’ll be damned!” he said. “It’s the quack.”

Robertson faced the Wilsons. “Sorry this has happened to you folks,” he said. “But I recognize the victim despite the fact that he looks a little worse for wear. His name is Dr. Dennis Hodges. In fact, this was his house, as you probably are aware.”

Angela’s eyes met David’s and she stifled a shiver. Gooseflesh had appeared on the back of her neck.

“What we have to do is knock the rest of this wall down so we can remove the body,” Robertson continued. “Do you folks have any problem with that?”

David said that they didn’t.

“What about calling the medical examiner?” Angela asked. Through her interest in forensics, she knew it was protocol to call the medical examiner on any suspicious death. This one certainly qualified.

Robertson regarded Angela for a few moments trying to think of something to say. He didn’t like anyone telling him how to do his job, especially a woman. The only problem was that Angela was right. And now that he’d been reminded he couldn’t ignore it.

“Where’s the phone?” Robertson said.

“In the kitchen,” Angela said.

Nikki had to be pried from the phone. She’d been back and forth between Caroline and Arni with the exciting news about finding a body in their basement.

Once the medical examiner had been called, Robertson and Morris set to work removing the cinder block wall.

David brought down an extension cord and a floor lamp to help them see what they were doing. The added light also gave them all a better look at the body. Although it was generally well preserved, there was some skeletonization of the lower half of the face. Some of the jawbones and most of the teeth were garishly exposed. The upper part of the face was surprisingly intact. The eyes were hideously open. In the center of the forehead at the hairline was a caved-in area covered with a green mold.

“That pile of stuff in the corner looks like empty cement bags,” Robertson said. He was using the beam of the flashlight as a pointer. “And there’s the trowel. Hell, he’s got everything in there with him. Maybe it was a suicide.”

David and Angela looked at each other with the same thought: Robertson was either the world’s worst detective or a devotee of crude humor.

“I wonder what those papers are?” Robertson said, directing the light at a number of scattered sheets of paper in the depths of the makeshift tomb.

“Looks like copy machine paper,” David said.

“Well, look at that,” Robertson said as he directed the flashlight at a tool that was partially concealed under the body. It resembled a flat crowbar.

“What is it?” David asked.

“That’s a pry bar,” Robertson said. “It’s an all-purpose tool, used mostly for demolition.”

Nikki called down the stairs to say that the medical examiner had arrived. Angela went up to meet him.

Dr. Tracy Cornish was a thin man of medium height with wire-rimmed spectacles. He carried a large, old-fashioned black leather doctor’s bag.

Angela introduced herself and explained that she was a pathologist at Bartlet Community Hospital. She asked Dr. Cornish if he’d had formal forensic training. He admitted he hadn’t, and he explained that he filled in as a district medical examiner to supplement his practice. “But I’ve been doing it for quite a number of years,” Dr. Cornish added.

“I was only asking because I have an interest in forensics myself,” Angela said. She hadn’t meant to embarrass the man.

Angela led Dr. Cornish down to the tomb. He stood and stared at the scene for a few minutes. “Interesting,” he said finally. “The body is in a particularly good state of preservation. How long has he been missing?”

“About eight months,” Robertson said.

“Shows what a cool, dry place will do,” Dr. Cornish said. “This tomb has been like a root cellar. It’s even dry after all this rain.”

“Why is there some skeletonization around the jaws?” David asked.

“Rodents, probably,” Dr. Cornish answered as he bent down and snapped open his bag.

David shuddered. His mouth had gone dry at the thought of rodents gnawing on the body. Glancing at Angela, he could tell that she had taken this information in stride and was fascinated by the proceedings.

The first thing Dr. Cornish did was take a number of photos, including extreme close-ups. Then he donned rubber gloves and began removing the objects from the tomb, placing them in plastic evidence bags. When he got to the papers, everyone crowded around to look at them. Dr. Cornish made certain that no one touched them.

“They’re part of medical records from Bartlet Community Hospital,” David said.

“I’ll bet these stains are all blood,” Dr. Cornish said, pointing to large brown areas on the papers. He put all the papers into a plastic bag which he then sealed and labeled.

When all the objects had been removed, Dr. Cornish turned his attention to the body. The first thing he did was search the pockets. He immediately found the wallet with bills still inside. There were also a number of credit cards in Dennis Hodges’ name.

“Well, it wasn’t a robbery,” Robertson said.

Dr. Cornish then removed Hodges’ watch, which was still running. The time was correct.

“One of the battery manufacturers should use this for one of their zany commercials,” Robertson suggested. Morris laughed until he realized no one else was.

Dr. Cornish then pulled a body bag out of his satchel and asked Morris to give him a hand getting Hodges into it.

“What about bagging the hands?” Angela suggested.

Dr. Cornish thought for a moment, then nodded. “Good idea,” he said. He got paper bags from his kit and secured them over Hodges’ hands. That done, he and Morris got the body into the bag and zipped it closed.

Fifteen minutes later the Wilsons watched as the police cruiser and the medical examiner’s van turned around, descended their driveway, and disappeared into the night.

“Anyone hungry?” Angela asked.

Both Nikki and David groaned.

“I’m not either,” Angela admitted. “What a night.”

They adjourned to the family room where David stoked the fire and added wood. Nikki turned on the television. Angela sat down to read.

By eight o’clock all three decided they might eat something after all. Angela reheated the dinner she had made while David and Nikki set the table.

“Every family has a skeleton in the closet,” David said when they were midway through the meal. “Ours just happened to be in the cellar.”

“I don’t think that’s very funny,” Angela said.

Nikki said she didn’t get it, and Angela had to explain the figurative meaning. Once Nikki understood, she didn’t think it was funny either.

David was not pleased about the gruesome discovery in their basement. He was particularly concerned about the potential effect on Nikki. He’d hoped bringing a little humor to the situation might defuse the tension. But even he had to admit his joke fell flat.

After Nikki’s respiratory treatment, they all went to bed. Though not an antidote, sleep seemed to be the best alternative. Although Nikki and David were sleepy, Angela wasn’t, and as she lay in bed she became acutely aware of all the sounds the house made. She had never realized how noisy it was, particularly on a windy, rainy night. From deep in the basement she heard the oil burner kick on. There was even an intermittent, very low-pitched whine from wind coming down the master bedroom flue.

A sudden series of thumps made Angela jump, and she sat upright.

“What’s that?” Angela whispered nervously. She gave David a shove.

“What’s what?” David asked, only half awake.

Angela told him to listen. The thumping occurred again. “There,” Angela cried. “That banging.”

“That’s the shutters hitting against the house,” David said. “Goodness sake, calm down!”

Angela lay back against the pillow, but her eyes were wide open. She was even less sleepy than she was when she’d gotten into bed.

“I don’t like what has been happening around here,” Angela said.

David audibly groaned.

“Really,” Angela said. “I can’t believe so much has changed in so few days. I was worried this was going to happen.”

“Are you talking specifically about finding Hodges’ body?” David asked.

“I’m talking about everything,” Angela said. “The change in the weather, Wadley’s harassing me, Marjorie’s death, Kelley’s harassing you, and now a body in our basement.”

“We’re just being efficient,” David said. “We’re getting all the bad stuff out of the way at one time.”

“I’m being serious, and  .  .  .” Angela began to say, but she was interrupted by a scream from Nikki.

In a flash both David and Angela were out of bed and running down the central corridor. They dashed into Nikki’s room. She was sitting in bed with a dazed look on her face. Rusty was next to her, equally confused.

It had been a nightmare about a ghoul in the basement. Angela sat on one side of Nikki’s bed and David on the other. Together they comforted their daughter. Yet they didn’t know quite what to say. The problem was that Nikki’s nightmare had been a mixture of dream and reality.

David and Angela did their best to comfort Nikki. In the end they invited her to come sleep with them in their bed. Nikki agreed, and they all marched back to the master bedroom. Climbing into bed, they settled down. Unfortunately David ended up sleeping on the very edge because inviting Nikki also meant inviting Rusty.