"Crisis" - читать интересную книгу автора (Cook Robin)

Prologue

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Autumn is a glorious season, despite its frequent use as a metaphor for approaching death and dying. Nowhere is its invigorating ambience and riotous color more apparent than in the northeastern United States. Even in early September the hot, hazy, humid days of the New England summer are progressively replaced by crystalline days with cool, clear, dry air and azure skies. September 8, 2005, was a case in point. Not a cloud marred the translucent sky from Maine to New Jersey, and within the macadam maze of downtown Boston and the concrete grid of New York City, the temperature was a comfortable seventy-seven degrees Fahrenheit.

As the day drew to a close, two doctors coincidently and reluctantly fumbled to pull their ringing cell phones from their belt clips in their respective cities. Neither was happy about the intrusion. Each was fearful that the melodic ring would herald a crisis that would require their professional attention and presence. An inopportune interruption, as both individuals were anticipating interesting personal evening activities.

Unfortunately, the doctors' intuitions were correct, since both calls were to give credence to autumn's metaphorical reputation. The call in Boston concerned someone about to die with the acute onset of chest pain, profound weakness, and difficulty breathing, while the one in New York was about someone recently but clearly already dead. Both situations were emergencies for the respective physicians, necessitating that they put their private plans on hold. What the doctors didn't know was that one of the calls would initiate a sequence of events that would seriously impact them both, put both in jeopardy, and turn them into bitter enemies, and the other call would ultimately put a different spin on the first!

Boston, Massachusetts 7:10 p.m.

Dr. Craig Bowman let his arms dangle at his sides for a moment to relieve his aching forearm muscles. He had been standing in front of the mirror that was attached to the backside of the closet door, struggling to tie a black formal bow tie. He'd worn a tuxedo at most a half a dozen times in his life, the first time at his high-school prom and the last time when he got married, and on all of those previous occasions, he'd been satisfied to snap on a pre-tied model that came with the rented tux. But now, in his reincarnation of himself, he wanted the genuine article. He'd bought himself a brand-new tuxedo and wasn't about to settle for a fake tie. The trouble was, he really didn't know how to tie it and had been embarrassed to ask the salesclerk. At the time, he hadn't been worried since he figured it would somehow be similar to tying his shoes.

Sadly, it was proving to be a lot different, and he had been attempting to tie the blasted thing for a good ten minutes. Luckily, Leona, his new and dynamite secretary-cum-file clerk and even newer companion, had been preoccupied with her makeup in the bathroom. Worst case, he'd have to ask her if she knew how to do it. Craig really didn't want to do that. They hadn't been seeing each other socially that long, and Craig preferred that she maintain her apparent belief in his sophistication, fearing he'd otherwise never hear the end of it. Leona had what his matronly receptionist-secretary and his nurse called a "mouth." Tactfulness wasn't her strong suit.

Craig shot a quick glance in Leona's direction. The door to the bathroom was ajar, and she was doing her eyes, but all he could see was a side view of her curvaceous twenty-three-year-old derriere covered with a lustrous pink silk crepe. She was on her tiptoes, leaning over the sink to get closer to the mirror. A fleeting, self-satisfied smile passed over Craig's face as he thought of them walking down the aisle of Symphony Hall that evening, which was why they were getting decked out in their finery. Compensating for being a "mouth," Leona was a "looker," especially in the low-cut dress that they had recently bought at Neiman Marcus. He was sure she was going to turn some heads and that he'd be dodging some envious looks from fellow forty-five-year-old men. Craig realized such feelings were rather juvenile, to say the least, but he'd not felt them since that first time he'd worn a tuxedo, and he was going to enjoy it.

Craig's smile faltered when the question occurred to him whether any of his and his wife's friends might be there in the audience. His goal certainly wasn't to humiliate anyone or hurt anyone's feelings. Yet he doubted he'd see any acquaintances, because he and his wife had never gone to the symphony, nor had any of their few friends, who were mostly overworked physicians like himself. Taking advantage of the city's cultural life hadn't been part of their particular suburban lifestyle, thanks to the hours a typical practice of medicine demanded.

Craig had been separated from Alexis now for six months, so it wasn't unreasonable to have a companion. He didn't think it was an age issue. As long as he was with an adult woman of a reasonable, post-college age, it shouldn't matter. After all, being seen out and about with a date was going to happen sooner or later, as active as he'd become. In addition to regular attendance at the symphony, he'd become a regular at a new gym, as well as at the theater, the ballet, and a number of other activities and social gatherings that normal educated people participated in in a world-class city. Since Alexis had consistently refused to go along with his new persona right from its inception, he now felt he was justified to accompany whomever he wanted. He wasn't going to be held back from becoming the person he aspired to be. He'd even joined the Museum of Fine Arts and was looking forward to exhibition openings, despite never having ever been to one. He'd had to sacrifice enjoying such cultural activities during the arduous and isolating effort of becoming a doctor – particularly, becoming the best doctor he could be – which meant that for ten years of his adult life, he was absent from the hospital only to sleep. And then once he'd finished his specialty training in internal medicine and hung out his proverbial shingle, he'd had even less time for personal pursuits of any kind, including, unfortunately, much family life. He'd become the archetypal, intellectually provincial workaholic with no time for anyone but his patients. But all that was changing, and regrets and guilt, particularly about family issues, had to be put on hold. The new Dr. Craig Bowman had left behind the lockstep, hurried, unfulfilling, and uncultured workaday life. He knew that some people might call his situation a midlife crisis, but he had a different name for it. He called it a rebirth or, more accurately, an awakening.

Over the previous year, Craig had become committed to – even obsessed with – transforming himself into a more interesting, hap-pier, well-rounded, better person and, because of it, a better doctor. On the desk of his in-town apartment was a pile of catalogues from various local universities, including Harvard. He intended to take classes in humanities: maybe one or two a semester to make up for lost time. And best of all, thanks to his makeover, he'd been able to return to his beloved research, which had completely fallen by the wayside once he'd started practice. What had started out in medical school as a remunerative job doing scut work for a professor studying sodium channels in muscle and nerve cells had turned into a passion when he was elevated to the level of a fellow researcher. Craig had even co-authored several scientific papers to great acclaim while he'd been a medical student and then resident. Now he was back at the bench, able to spend two afternoons a week in the lab, and he loved it. Leona called him a Renaissance man, and although he knew the description was premature, he thought that with a couple of years of effort, he might come close.

The origin of Craig's metamorphosis had been rather sudden and had taken him by complete surprise. Just over a year previously, and quite serendipitously, his professional life and practice had changed dramatically with the double benefit of significantly raising his income as well as his job satisfaction. All at once it had become possible for him truly to practice the kind of medicine he'd learned in medical school, where patients' needs eclipsed the arcane rules of their insurance coverage. Suddenly, Craig could spend an hour with someone if the patient's situation required it. Appropriately, it had become his decision. In one fell swoop, he'd been freed of the dual scourge of falling reimbursements and rising costs that had forced him to squeeze more and more patients into his busy day. To get paid, he no longer had to fight with insurance personnel who were often medically ignorant. He'd even started making house calls when it was in the patient's best interest, an action that had been unthinkable in his former life.

The change had been a dream come true. When the offer had unexpectedly come over the transom, he'd told his would-be benefactor and now partner that he'd have to think about it. How could he have been so stupid not to agree on the spot? What if he had missed the opportunity to grab the brass ring? Everything was better, save for the family problem, but the root of that issue was how submerged he'd been from day one in his former professional situation. Ultimately, it had been his fault, which he freely admitted. He had let the exigencies of current medical practice dictate and limit his life. But now he certainly wasn't drowning, so maybe the family difficulties could be resolved in the future, given enough time. Maybe Alexis could be convinced how much better all their lives could be. Meanwhile, he resolved to enjoy bettering himself. For the first time in his life, Craig had free time and money in the bank.

With an end of the bow tie in each hand, Craig was about to try tying it again when his cell phone rang. His face fell. He glanced at his watch. It was ten after seven. The symphony was to start at eight thirty. His eyes switched to the caller ID. The name was Stanhope.

"Damn!" Craig blurted with emphasis. He flipped open his phone, put it to his ear, and said hello.

"Doctor Bowman!" a refined voice said. "I'm calling about Patience. She's worse. In fact, this time I think she's really sick."

"What seems to be the problem, Jordan?" Craig asked as he turned to glance back into the bathroom. Leona had heard the phone and was looking at him. He mouthed the name Stanhope, and Leona nodded. She knew what that meant, and Craig could tell from her expression that she had the same fear he had – namely, that their evening was now in jeopardy. If they arrived at the symphony too late, they'd have to wait for the intermission to sit down, which meant forgoing the fun and excitement of the entrance, which both had been keenly anticipating.

"I don't know," Jordan said. "She appears unnaturally weak. She doesn't even seem to be able to sit up."

"Besides weakness, what are her symptoms?"

"I think we should call an ambulance and go to the hospital. She's greatly perturbed, and she's got me concerned."

" Jordan, if you are concerned, then I am, too," Craig said soothingly. "What are her symptoms? I mean, I was just there at your home this morning dealing with her usual medley of complaints. Is it something different or what?" Patience Stanhope was one of less than a half-dozen patients that Craig labeled "problem patients," but she was the worst of the group. Every doctor had had them, in every kind of practice, and found them tedious at best and maddening at worst. They were the patients who persisted day in and day out with a litany of complaints that were, for the most part, completely psychosomatic or totally phantom and that could rarely be helped by any therapy, including alternative medicine. Craig had tried everything with such patients, to no avail. They were generally depressed, demanding, frustrating, and time-consuming, and now with the Internet, quite creative with their professed symptoms and desire for lengthy conversations and hand-holding. In his previous practice, after ascertaining their hypochondriasis beyond a reasonable doubt, Craig would arrange to see them as infrequently as possible, mostly by shunting them off to the nurse practitioner or to the nurse or, rarely, to a subspecialist if he could get them to go, particularly to see a psychiatrist. But in Craig's current practice setup, he was limited in his ability to resort to such ruses, meaning the "problem patients" were the only bugbears of his new practice. Representing only three percent of his patient base, as reported by the accountant, they consumed more than fifteen percent of his time. Patience was the prime example. He had been seeing her at least once a week over the last eight months and, more often than not, in the evening or at night.

As Craig frequently quipped to his staff, she was trying his patience. The comment never failed to get a laugh.

"This is far different," Jordan said. "It's entirely dissimilar to her complaints last evening and morning."

"How so?" Craig asked. "Can you give me some specifics?" He wanted to be as certain as possible about what was going on with Patience, forcing himself to remember that hypochondriacs occasionally actually got sick. The problem with dealing with such patients was that they lowered one's index of suspicion. It was like the allegory of the shepherd boy crying wolf.

"The pain is in a different location."

"Okay, that's a start," Craig said. He shrugged for Leona's benefit and motioned for her to hurry. If the current problem was what he thought, he wanted to take Leona along on the house call. "How is the pain different?"

"The pain this morning was in her rectum and the lower part of her belly."

"I remember!" Craig said. How could he forget? Bloating, gas, and problems with elimination described in disgustingly exquisite detail were the usual complaints. "Where is it now?"

"She says it's in her chest. She's never complained of pain in her chest before."

"That's not quite true, Jordan. Last month there were several episodes of chest pain. That's why I gave her a stress test."

"You're right! I forgot about that. I can't keep up with all her symptoms."

You and me both, Craig wanted to say, but he held his tongue.

"I think she should go to the hospital," Jordan repeated. "I believe she's having some difficulty breathing and even talking. Earlier, she managed to tell me she had a headache and was sick to her stomach."

"Nausea is one of her common afflictions," Craig interjected. "So is the headache."

"But this time she threw up a little. She also said she felt like she was floating in the air and kind of numb."

"Those are new ones!"

"I'm telling you, this is altogether different."

"Is the pain visceral and crushing, or is it sharp and intermittent like a cramp? "I can't say."

"Could you ask her? It may be important."

"Okay, hold the line!"

Craig could hear Jordan drop the receiver. Leona came out of the bathroom. She was ready. To Craig, she looked like she belonged on the cover of a magazine. He indicated as much by giving her a thumbs-up. She smiled and mouthed: "What's happening?"

Craig shrugged, keeping the cell phone pressed to his ear but twisting it away from his mouth. "Looks like I'm going to have to make a house call."

Leona nodded, then questioned: "Are you having trouble with your tie?"

Craig reluctantly nodded.

"Let's see what I can do," Leona suggested.

Craig raised his chin to give her more room to work as Jordan came back on the line. "She says the pain is terrible. She says it's all of those words you used."

Craig nodded. That sounded like the Patience he was all too familiar with. No help there. "Does the pain radiate anywhere, like to her arm or neck or any other place?"

"Oh my word! I don't know. Should I ask her?"

"Please," Craig replied.

After a few deft maneuvers, Leona pulled on the looped ends of the bow tie and tightened the knot she had made. After a minor adjustment, she stepped back. "Not bad, even if I say so myself," she declared.

Craig looked at himself in the mirror and had to agree. She had made it look easy.

Jordan 's voice came over the phone. "She says it's just in her chest. Are you thinking she's experiencing a heart attack, doctor?"

"It has to be ruled out, Jordan," Craig said. "Remember, I told you she had some mild changes on her stress test, which is why I advised more investigation of her cardiac status, even though she was not inclined."

"I do remember now that you mention it. But whatever the current affliction, I believe it's progressing. I believe she even appears rather blue."

"Okay, Jordan, I'll be right there. But one other quick question: Did she take any of those antidepressant pills I left this morning?"

"Is that important?"

"It could be. Although it doesn't sound like she is having a drug reaction, we have to keep it in mind. It was a new medication for her. That's why I told her not to start until tonight when she went to bed, just in case they made her dizzy or anything."

"I have no idea if she did or not. She has a lot of medication she got from Dr. Cohen."

Craig nodded. He knew very well that Patience's medicine cabinet looked like a miniature pharmacy. Dr. Ethan Cohen was a much more liberal prescriber of medication than Craig, and he had originally been Patience's physician. It had been Dr. Cohen who had offered Craig the opportunity to join his practice, but he was currently Craig's partner more in theory than in fact. The man was having his own health issues and was on an extended leave that might end up being permanent. Craig had inherited his entire current roster of problem patients from his absent partner. To Craig's delight, none of his problem patients from his previous practice had decided to pay the required fee to switch to the new practice.

" Listen, Jordan," Craig said. "I'm on my way, but make an effort to find the small vial of sample pills I gave Patience this morning so we can count them."

"I will give it my best effort," Jordan said.

Craig flipped his phone shut. He looked at Leona. "I've definitely got to make a house call. Do you mind coming with me? If it turns out to be a false alarm, we can go directly to the concert and still make the entree. Their house is not that far from Symphony Hall."

"Fine by me," Leona said cheerfully.

While pulling on his tuxedo jacket, Craig went quickly to his front closet. From the top shelf, he got his black bag and snapped it open. It had been a gift from his mother when he'd graduated from medical school. At the time it had meant a mountain to Craig because he had an idea of how long his mom had to have squirreled money away without his father knowing to afford it. It was a sizable, old-fashioned doctor's bag made of black leather with brass hardware. In his former practice, Craig had never used it since he didn't make house calls. But over the last year he'd used it a lot.

Craig tossed a bunch of supplies he thought he might need into the bag, including a bedside assay kit for myocardial infarction or heart attack biomarkers. Science had advanced since he'd been a resident. Back then it could take days to get the results back from the lab. Now he could do it at the bedside. The assay wasn't quantitative, but that didn't matter. It was proof of the diagnosis that was important. Also from the top shelf he pulled down his portable ECG machine, which he handed to Leona.

When Craig had formally separated from Alexis, he had found an apartment on Beacon Hill in the center of Boston. It was a fourth-floor walk-up duplex on Revere Street with good sunlight, a deck, and a view over the Charles River to Cambridge. The Hill was central to the city and fulfilled Craig's needs superbly, especially since he could walk to several good restaurants and the theater district. The only minor inconvenience was the parking problem. He had to rent a space in a garage on Charles Street, a five-minute walk away.

"What are the chances we can get away in time for the concert?" Leona asked when they were on their way in Craig's new Porsche, speeding westward on Storrow Drive.

Craig had to raise his voice against the whine of the engine. " Jordan seems to think this might be legit. That's what scares me. Living with Patience, he knows her better than anybody."

"How can he live with her? She's such a pain in the ass, and he seems like quite a refined gentleman." Leona had observed the Stanhopes in the office on a couple of occasions.

"I imagine there are benefits. I have a sense she is the one with the money, but who knows. People's private lives are never what they seem, including my own, until recently." He gave Leona's thigh a squeeze.

"I don't know how you have such patience with such people," Leona marveled. "No pun intended."

"It's a struggle, and between you and me, I can't stand them. Luckily, they are a distinct minority. I was trained to take care of sick people. Hypochondriacs to me are the same as malingerers. If I had wanted to be a psychiatrist, I would have studied psychiatry."

"When we get there, should I wait in the car?"

"It's up to you," Craig said. "I don't know how long I'll be. Sometimes she corners me for an hour. I think you should come in. It would be boring to sit in the car."

"It will be interesting to see how they live."

"Hardly the average couple."

The Stanhopes lived in a massive, three-story, Georgian-style brick house on a sizable wooded lot near the Chestnut Hill Country Club in an upscale area of Brighton, Massachusetts. Craig entered the circular drive and pulled up to the front of the building. He knew the route all too well. Jordan had the door open as they mounted the three steps. Craig had the black bag; Leona carried the ECG machine.

"She is upstairs in her bedroom," Jordan said quickly. He was a tall, meticulous man dressed in a dark green velvet smoking jacket. If he marveled at Craig and Leona's formal attire, he didn't let on. He held out a small plastic vial and dropped it in Craig's hand before turning on his heel.

It was the free sample bottle of Zoloft Craig had given Patience that morning. Craig could see immediately that one of the six pills was missing. Obviously, she had started the medication earlier than Craig had suggested. He pocketed the vial and started after Jordan. "Do you mind if my secretary comes along?" Craig called out. "She can possibly lend me a hand." Leona had demonstrated a few times in the office her willingness to help out. Craig had been impressed by her initiative and commitment from the start, long before he thought of asking her to a social event. He was equally impressed that she was taking night courses at Bunker Hill Community College in Charlestown, with the idea of eventually getting some sort of medical degree as a technician or nurse. For him, it added to her appeal.

"Not at all," Jordan responded over his shoulder, waving for them to follow. He had started up the main staircase that skirted the Palladian window above the front door.

"Separate bedrooms," Leona whispered to Craig as they hurried after Jordan. "It kind of defeats the purpose. I thought that was only in old movies."

Craig didn't respond. They quickly descended a long carpeted hallway and entered the feminine master suite upholstered in a square mile of blue silk. Patience, her eyelids heavy, was lying in a king-size bed, semi-propped up with overstuffed pillows. A servant in a demure French maid's outfit straightened up. She had been holding a moist cloth against Patience's forehead.

With a quick glance at Patience and without saying a word, Craig rushed over to the woman, dropped the bag on the bed next to her, and felt for a pulse. He snapped open the bag and pulled out his blood-pressure cuff and stethoscope. As he wrapped the cuff around Patience's right arm, he barked to Jordan: "Call an ambulance!"

With only a slight elevation of his eyebrows to indicate he had heard, Jordan went to the nightstand phone and dialed 911. He gave the servant woman a wave of dismissal.

"Good Lord!" Craig murmured as he tore off the cuff. He snapped the pillows from behind Patience's body and her torso fell back onto the bed like a rag doll. He yanked down the covers and pulled open her negligee, then listened briefly to her thorax with his stethoscope before motioning to Leona to give him the ECG machine. Jordan could be heard speaking with the 911 operator. Craig fumbled to unsnarl the ECG leads and quickly attached them with a bit of conducting jelly.

"Is she going to be all right?" Leona asked in a whisper.

"Who the hell knows," Craig answered. "She's cyanotic, for Christ's sake."

"What's cyanotic?"

"There's not enough oxygen in her blood. I don't know if it's because her heart isn't pumping enough or she's not breathing enough. It's one or the other or both."

Craig concentrated on the ECG machine as it spewed out a tracing. There were only little blips, widely spaced. Craig tore off the output strip and took a quick, closer glance at it before jamming it into his jacket pocket. He then snapped the leads off Patience's extremities.

Jordan hung up the phone. "The ambulance is on its way."

Craig merely nodded as he rapidly rummaged in his bag and pulled out an Ambu breathing bag. He placed the mask over Patience's nose and mouth and compressed the bag. Her chest rose easily suggesting good ventilation.

"Could you do this?" Craig asked Leona as he continued to ventilate Patience.

"I guess so," Leona said hesitantly. She squeezed between Craig and the headboard and took over the assisted breathing.

Craig showed her how to maintain a seal and keep Patience's head back. He then glanced at Patience's pupils. They were widely dilated and unreactive. It wasn't a good sign. With the stethoscope, he checked Patience's breath sounds. She was being aerated well.

Back in his black bag, Craig pulled out the assay kit for testing for the biomarkers associated with a heart attack. He tore open the box and pulled out one of the plastic devices. He used a small, heparinized syringe to get some blood from a major vein, shook it, and then put six drops into the sample area. He then held the device under the light.

"Well, that's positive," he said after a moment. He then haphazardly tossed everything back into his bag. "What is positive?" Jordan asked.

"Her blood is positive for myoglobin and troponin," Craig said. "In layman's terms, it means she's had a heart attack." With his stethoscope, Craig ascertained that Leona was ventilating Patience appropriately.

"So your initial impression was correct," Jordan commented.

"Hardly," Craig said. "I'm afraid I have to say, she is in a very bad situation."

"I was trying to communicate as much on the phone," Jordan said stiffly. "But at the moment, I was referring to the heart attack."

"She is worse off than you led me to believe," Craig said as he got out some epinephrine and atropine, along with a small bottle of intravenous fluid.

"I beg your pardon. I was quite clear she was progressively getting worse."

"You said she was having a little trouble breathing. Actually, she was hardly breathing at all when we got here. You could have let me know that. You said you believed she was rather blue, whereas I find her totally cyanotic." Craig deftly started an intravenous infusion. He taped the needle in place and gave the epinephrine and atropine. He hung the small IV bottle from the lampshade with a small S hook he had made for that specific purpose.

"I was doing the best I could to communicate to you, doctor."

"I appreciate that," Craig said, holding up his hands in a conciliatory gesture. "I'm sorry. I don't mean to be critical. I'm just concerned about your wife. What we need to do now is get her to the hospital as quickly as we can. She needs to be ventilated with oxygen, and she needs a cardiac pacer. On top of that, I'm certain she is acidotic and must be treated for it."

The undulating sound of the approaching ambulance could be heard in the distance. Jordan left to go downstairs to let in the emergency technicians and direct them up to Patience's room.

"Is she going to make it?" Leona asked as she continued compressing the Ambu bag. "She doesn't look quite as blue to me."

"You're doing a great job with that breathing bag," Craig responded. "But I'm not optimistic, since her pupils haven't come down, and she's so flaccid. But we'll know better when we get her over to Newton Memorial Hospital, get some blood work, get her on a respirator and a pacer. Would you mind driving my car? I want to ride in the ambulance in case she arrests. If she needs CPR, I want to do the chest compressions."

The EMTs were an efficient team. It was a man and a woman who obviously had worked together for some time, since they anticipated each other's moves. They swiftly moved Patience to a gurney, brought her downstairs, and loaded her into the ambulance. Within just a few minutes of their arrival at the Stanhope residence, they were back on the road. Recognizing a true emergency, they had the siren screaming and the woman drove accordingly. En route, the male EMT phoned ahead to Newton Memorial to advise them of what to expect.

Patience's heart was still beating, but barely, when they arrived. A staff cardiologist whom Craig knew well had been summoned, and she met them on the unloading dock. Patience was rolled inside with dispatch, and an entire team began to work on her. Craig told the cardiologist what he could, including the results of the biomarker assay confirming the diagnosis of myocardial infarction, or heart attack.

As Craig had anticipated, Patience was first put on a respirator with one hundred percent oxygen followed by an external pacemaker. Unfortunately, it was quickly confirmed that she then had the problem of PEA, or pulseless electrical activity, meaning the pacemaker was creating an image on the electrocardiogram but the heart was not responding with any beats. One of the residents climbed up onto the table to start chest compressions. Blood work came back and the blood gases were not bad, but the acid level was close to the highest the cardiologist had ever seen.

Craig and the cardiologist looked at each other. Both knew from experience that PEA had a dismal outcome with a hospital inpatient, even when caught quickly. The situation with Patience was far worse, since she had come in by ambulance.

After several hours of attempting all possible efforts to get the heart to respond, the cardiologist took Craig aside. Craig was dressed in his formal shirt, complete with bow tie still in place. Blood spatter adorned the upper part of his right arm, and his tuxedo jacket hung on a spare IV pole against the wall.

"It must have been extensive cardiac muscle damage," the cardiologist said. "It's the only way to explain all the conduction abnormalities and the PEA. Things might well have been different if we had been able to start on her a bit sooner. From your description of the time course, I imagine the size of the initial infarct significantly grew."

Craig nodded. He looked back at the team that was still doing cardiopulmonary resuscitation on Patience's slim frame. Ironically, her color had returned to near normal with the oxygen and the chest compressions. Unfortunately, they had run out of things to try.

"Did she have a history of cardiovascular disease?"

"She had an equivocal stress test a few months ago," Craig said. "It was suggestive of a mild problem, but the patient refused any follow-up studies."

"To her detriment," the cardiologist said. "Unfortunately, her pupils have never come down, suggesting anoxic brain damage. With that in mind, what do you want to do? It's your call."

Craig took in a deep breath and let it out noisily as a reflection of his discouragement. "I think we should stop."

"I agree one hundred percent," the cardiologist said. She gave Craig's shoulder a reassuring squeeze, then walked back to the table to tell the team it was over.

Craig got his tuxedo jacket and walked over to the ER desk to sign the paperwork indicating the patient was deceased and that the cause was cardiac arrest following myocardial infarction. Then he went out into the emergency room waiting area. Leona was seated among the sick, the injured, and their families. She was flipping through an old magazine. Dressed as she was, she appeared to Craig like a nugget of gold among nondescript gravel. Her eyes rose up as he approached. He could tell she read his expression.

"No luck?" she said.

Craig shook his head. He scanned the waiting area. "Where is Jordan Stanhope?"

"He left over an hour ago."

"Really? Why? What did he say?"

"He said he preferred to be at home, where he would await your call. He said something about hospitals depressing him."

Craig gave a short laugh. "I guess that's consistent. I always thought of him as a rather cold, odd duck who was just going through the motions with his wife."

Leona tossed aside the magazine and followed Craig out into the night. He thought about saying something philosophical about life to Leona but changed his mind. He didn't think she'd understand, and he was worried he wouldn't be able to explain it. Neither spoke until they got to the car.

"Do you want me to drive?" Leona asked.

Craig shook his head, opened the passenger door for Leona, then walked around and climbed in behind the wheel. He didn't start the car immediately. "We obviously missed the concert," he said, staring out through the windshield.

"To say the least," Leona said. "It's after ten. What would you like to do?"

Craig didn't have any idea. But he knew he had to call Jordan Stanhope and wasn't looking forward to it.

"Losing a patient must be the hardest thing about being a doctor," Leona said.

"Sometimes it's dealing with the survivors," Craig responded, without any idea how prophetic his comment would turn out to be.

New York, New York 7:10 p.m.

Dr. Jack Stapleton had been sitting in his cramped office on the fifth floor of the Office of the Chief Medical Examiner for more hours than he was willing to admit. His office mate, Dr. Chet McGovern, had deserted him just after four when Chet left for his workout at his posh Midtown gym. As was often the case, he'd badgered Jack to come along with glowing tales of the newest batch of nubile female members in his body-sculpting class with their skintight outfits that left nothing to the imagination, but Jack had begged off with his customary rejoinder that he preferred being a participant rather than an observer when it came to sports. He couldn't believe that Chet could still laugh at what had become such a hackneyed comeback.

At five o'clock Dr. Laurie Montgomery, Jack's colleague and soul mate, had poked her head in to say she was heading home to shower and change for the romantic rendezvous Jack had arranged for the two of them that evening at their favorite New York restaurant, Elio's, where they had had a number of memorable dinners over the years. She had suggested he come along to freshen up as well, but he again begged off, saying he was swamped with work and he'd meet her at the restaurant at eight. Unlike Chet, she didn't try to change his mind. From her perspective, it was such a rare event for Jack to be so resourceful on a weeknight that she wanted to bend over backward in hopes of encouraging such behavior. His usual evening plans included a death-defying dash home on his mountain bike, a strenuous run on the neighborhood basketball court with his neighborhood buddies, a quick salad at one of the Columbus Avenue restaurants around nine, followed soon after by a mute collapse into bed.

Despite what he had said, Jack didn't have that much to do and had been scrounging around to keep himself busy, particularly over the last hour. Even before he had sat down at his desk, he had been reasonably caught up with all his outstanding autopsy cases. The reason he was forcing himself to labor this particular afternoon was to keep his mind occupied in a vain attempt to control the anxiety he felt about his secret plans for the evening. The process of submerging himself in either his work or strenuous athletic activity had been his balm and salvation for more than fourteen years, so he wasn't about to abandon the ruse now. Unfortunately, his contrived work wasn't holding his interest, especially since he was running out of things to do. His mind was beginning to wander into forbidden areas, which began to torment him into having second thoughts about the evening's plans. It was at that moment that his cell phone came to life. He glanced at his watch. There was less than an hour to go before D-day. He felt his pulse accelerate. A phone call at that moment was an inauspicious sign. Since the chances of it being Laurie were nil, the chances were huge that it was someone who could throw the evening's schedule out of whack.

Pulling the phone from his belt clip, Jack eyed the LCD screen. Just as he feared, it was Allen Eisenberg. Allen was one of the pathology residents who was being paid by the Office of the Chief Medical Examiner to cover routine problems after hours, which the forensic investigator on duty thought needed the attention of a medical doctor. If the problem was beyond the pathology resident's comfort zone, then the medical examiner on call had to be contacted. Tonight, it was Jack.

"Sorry to have to call you, Dr. Stapleton," Allen said, his voice whiny and grating.

"What's the problem?"

"It's a suicide, sir."

"Okay, so what's the question? Can't you guys handle it?" Jack didn't know Allen very well, but he knew Steve Marriott, the evening forensic investigator, who was experienced.

"It's a high-profile case, sir. The deceased is the wife or girlfriend of an Iranian diplomat. He's been screaming at everyone and threatening to call the Iranian Ambassador. Mr. Marriott called me for backup, but I feel like I'm in over my head."

Jack didn't respond. It was inevitable: He would have to visit the scene. Such high-profile cases invariably took on political implications, which was the part of Jack's job that he detested. He had no idea if he'd be able to make the site visit and still get to the restaurant by eight, which only added to his anxiety.

"Are you still there, Dr. Stapleton?"

"Last time I looked," Jack retorted.

"I thought maybe we'd been cut off," Allen said. "Anyway, the location is apartment fifty-four-J in the United Nations Towers on Forty-seventh Street."

"Has the body been moved or touched?" Jack pulled on his brown corduroy jacket, unconsciously patting the square object in its right pocket.

"Not by me or the forensics investigator."

"What about by the police?" Jack started down the hallway toward the elevators. The hall was deserted.

"I don't believe so, but I didn't ask yet."

"What about by the husband or boyfriend?"

"You should ask the police. The detective in charge is standing next to me, and he wants to talk with you."

"Put him on!"

"Hey, buddy!" a loud voice said, forcing Jack to pull the phone away from his ear. "Get your ass over here!"

Jack recognized the gravelly voice as that of his friend of ten years, Detective Lieutenant Lou Soldano of the homicide division of the New York City Police Department. Jack had known Lou almost as long as he had known Laurie. It had been Laurie who had introduced them.

"I might have known you'd be behind this!" Jack lamented. "I hope you remember that we're supposed to be at Elio's at eight."

"Hey, I don't schedule this crap. It happens when it happens."

"What are you doing at a suicide? You guys think it might not be?"

"Hell, no! It's a suicide, all right, with a contact gunshot wound to the right temple. My presence is a special request from my beloved captain in appreciation of the parties involved and how much flak they are potentially capable of producing. Are you coming or what?"

"I'm on my way. Has the body been moved or touched?"

"Not by us."

"Who is that yelling in the background?"

"That's the diplomat husband or boyfriend. We have yet to figure that out. He's a little squirt, but he's feisty and makes me appreciate the silent, grieving type. He's been yelling at us since we got here, trying to boss us around like he's Napoleon."

"What's his problem?" Jack asked.

"He wants us to cover his naked wife or girlfriend, and he's madder than hell because we insist on not disturbing the scene until you guys finish checking it out."

"Hold on!" Jack said. "Are you telling me the woman's naked?"

"Naked as a jaybird. And to top it off, she doesn't even have any pubic hair. She's shaved like a cue ball, which -"

"Lou!" Jack interrupted. "It wasn't a suicide!"

"Excuse me?" Lou questioned with disbelief. "Are you trying to tell me you can tell this was a homicide without even seeing the scene?"

"I'll look at the scene, but yes, I'm telling you it wasn't a suicide. Was there a note?"

"Supposedly, but it's in Farsi. So I don't know what it says. The diplomat says it's a suicide note."

"It wasn't a suicide, Lou," Jack repeated. The elevator arrived. He boarded but kept the door from closing. He didn't want to lose the connection with Lou. "I'll even put a fiver on it. I've never heard of a case of a woman committing suicide in the nude. It just doesn't happen."

"You're joking!"

"No, I'm not. The thought is that's not the way women suicide victims want to be found.You'd better act accordingly and get your crime-scene people there. And you know the feisty diplomat husband or whatever he is has got to be your number-one suspect. Don't let him disappear into the Iranian mission. You might not see him again."

The elevator door closed as Jack flipped his phone shut. He hoped there wasn't a deeper meaning behind the interruption of the evening's plans. Jack's true bete noire was the fear that death stalked the people he loved, making him complicit when they died. He looked at his watch. It was now twenty after seven. "Damn!" he said out loud and slapped the elevator door a few times with the palms of his hands in frustration. Maybe he should rethink the whole idea.

With rapidity born of repetition, Jack got his mountain bike from the area of the morgue where the Potter's Field coffins were stored, unlocked it, put on his helmet, and wheeled it out onto the 30th Street loading dock. Between the mortuary vans, he climbed on and cycled out into the street. At the corner, he turned right onto First Avenue.

Once he was on the bike, Jack's anxieties melted away. Standing up, he put muscle into his pumping and the bike shot forward, rapidly picking up speed. Rush-hour traffic had abated to a degree, and the cars, taxis, buses, and trucks were moving at a good clip. Jack was not able to keep up, but it was close. Once he had achieved his cruising speed, he settled back onto the seat and shifted into a higher gear. From his daily bike riding and basketball playing, he was in tip-top shape.

The evening was glorious, with a golden glow suffusing the cityscape. Individual skyscrapers stood out sharply against the blue sky, the hue of which was deepening with every passing minute. Jack streaked past the New York University Medical Center on his right and, a little further north, the UN General Assembly complex. When he could, Jack moved to his left so that he was able to turn onto 47th Street, which was one-way, conveniently heading east.

The UN Towers was a few doors up from First Avenue. Sheathed in glass and marble, the structure soared up an impressive sixty-some-odd stories into the evening sky. Directly in front of the awning that stretched from its entrance to the street were several New York City squad cars with their lights flashing. Hardened New Yorkers walked by without a glance. There was also a battered Chevy Malibu double-parked next to one of the squad cars. Jack recognized it as Lou's. In front of the Malibu was a Health and Human Services mortuary van.

As Jack locked his bike to a no-parking signpost, his anxieties returned. The ride had been too short to have any lasting effect. It was now seven thirty. He flashed his medical examiner's badge to the uniformed doorman and was directed to the fifty-fourth floor.

Up in apartment 54J, things had quieted considerably. When Jack walked in, Lou Soldano, Allen Eisenberg, Steve Marriott, and a number of uniformed officers were sitting around the living room as if it were a doctor's waiting room.

"What gives?" Jack asked. Silence reigned. There wasn't even any conversation.

"We're waiting on you and the crime-scene people," Lou said as he got to his feet. The others followed suit. Instead of Lou's signature rumpled and slightly disheveled attire, he was wearing a neatly pressed shirt buttoned to the neck, a subdued new tie, and a tasteful although not terribly well-fitted glen plaid sport jacket that was too small for his stocky frame. Lou was a seasoned detective, having been in the organized-crime unit for six years before moving over to homicide, where he'd been for more than a decade, and he looked the part.

"I have to say you look pretty spiffy," Jack commented. Even Lou's closely cropped hair looked recently brushed, and his famous five o'clock shadow was nowhere to be seen.

"This is as good as it gets," Lou commented, lifting his arms as if flexing his biceps for effect. "In celebration of your dinner party, I snuck home and changed. What's the occasion, by the way?"

"Where's the diplomat?" Jack asked, ignoring Lou's question. He glanced into the kitchen and a room that was used as a dining room. Except for the living room, the apartment seemed empty.

"He's flown the coop," Lou said. "He stormed out of here just after I hung up with you, threatening all of us with dire consequences."

"You shouldn't have let him go," Jack said.

"What was I supposed to do?" Lou complained. "I didn't have an arrest warrant."

"Couldn't you have held him for questioning until I got over here?"

"Listen, the captain sent me on this case to keep things simple and not to rock the boat. Holding that guy at this stage would be rocking the boat big-time."

"Okay!" Jack said. "That's your problem, not mine. Let's see the body."

Lou gestured toward the open bedroom door.

"Do you have an ID on the woman yet?" Jack asked.

"Not yet. The building supervisor says she'd only been here less than a month and didn't speak much English."

Jack took in the scene before homing in on the body. There was a slight butcher-shop odor. The decor read designer. The walls and carpet were all black; the ceiling mirrored; and the curtains, clutter of knick-knacks, and furniture all white, including the bed linens. As Lou had explained, the corpse was completely naked, lying supine across the bed with the feet dangling over the bed's left side. Although darkly complected in life, she was now ashen against the sheet except for some bruising about the face, including a black eye. Her arms were splayed out to the sides with the palms up. An automatic pistol was loosely held in her right hand, with her index finger inside the trigger guard. Her head was turned slightly toward the left. Her eyes were open. High on the right temple was evidence of an entrance gunshot wound. Behind the head on the white sheet was a large bloodstain. Extending away from the victim to her left was some blood spatter, along with bits of tissue.

"Some of these Middle Eastern guys can be brutal with their women," Jack said.

"So I've heard," Lou said. "Is that bruising and black eye from the bullet wound?"

"I doubt it," Jack said. Then he turned back to Steve and Allen. "Have our pictures been taken of the body?"

"Yes, they have," Steve Marriott called from over near the door.

Jack pulled on a pair of latex rubber gloves and carefully separated the woman's dark, almost black hair to expose the entrance wound. There was a distinct stellate form to the lesion, indicating that the muzzle of the gun had been in contact with the victim when it had discharged.

Carefully, Jack rolled the woman's head to the side to look at the exit wound. It was low down below the left ear. He straightened up. "Well, that's more evidence," he said.

"Evidence of what?" Lou asked.

"That this wasn't a suicide," Jack said. "The bullet traveled from above on an angle downward. That's not the way people shoot themselves." Jack formed a gun with his right hand and placed the tip of his index finger as the hypothetical muzzle next to his temple. The plane of the finger was parallel with the floor. "When people shoot themselves, the track of the bullet is generally almost horizontal or maybe slightly upward, never downwards. This was a homicide staged to look like a suicide."

"Thanks a lot," Lou grumbled. "I was hoping your deduction about her being naked would prove to be wrong."

"Sorry," Jack said.

"Any idea how long she's been dead?"

"Not yet, but a wild guess would say not that long. Anybody hear a gunshot? That would be more accurate."

"Unfortunately, no," Lou said.

"Lieutenant!" one of the uniformed policemen called out from the doorway. "The crime-scene boys have arrived."

"Tell them to get their butts in here," Lou responded over his shoulder. Then, to Jack, he asked: "Are you done or what?"

"I'm done. We'll have more information for you in the morning. I'll be sure to do the post myself."

"In that case, I'll try to make it, too." Over the years, Lou had learned to appreciate how much information could be gleaned from victims of homicide during an autopsy.

"All right then," Jack said, snapping off the gloves. "I'm out of here." He glanced at his watch. He wasn't late yet, but he was going to be. It was seven fifty-two. It was going to take him more than eight minutes to get to the restaurant. He looked at Lou, who was bending over to examine a small tear in the sheet several feet away from the body in the direction of the headboard. "What do you have?"

"What do you think of this? Think it might be where the slug penetrated the mattress?"

Jack leaned over to examine the centimeter-long, linear defect. He nodded. "That would be my guess. There's a tiny bit of bloodstain along the edges."

Lou straightened up as the crime-scene technicians carried in their equipment. Lou mentioned getting the slug, and the technicians assured him they'd do their best.

"Are you going to be able to get away from here at some reasonable time?" Jack inquired.

Lou shrugged. "No reason why I can't leave with you. With the diplomat out of the picture, there's no reason for me to hang around. I'll give you a lift."

"I've got my bike," Jack said.

"So? Put it in my car. You'll get there sooner. Besides, it's safer than that bike of yours. I can't believe Laurie still lets you ride that thing around the city, particularly when you guys see so many of those messengers who get flattened."

"I'm careful," Jack said.

"My ass you're careful," Lou responded. "I've seen you streaking around the city on more than one occasion."

Jack debated what to do. He wanted to ride the bike for its calming effect and also because he couldn't stand the odor of the fifty billion cigarettes that had been smoked in Lou's Chevy, but he had to admit that with Lou driving, the car would be quicker, and the hour was fast approaching. "All right," he said reluctantly.

"My goodness gracious, a spark of maturity," Lou said. He took out his keys and tossed them to Jack. "While you're dealing with the bike, I'll have a word with my boys to make sure they are squared away."

Ten minutes later, Lou was driving north on Park Avenue, which he claimed would be the fastest route uptown. Jack's bike was in the backseat with both wheels removed. Jack had insisted that all four windows be rolled down, which made the interior of the car breezy but bearable, despite the overflowing ashtray.

"You seem kind of wired," Lou said as they skirted Grand Central station on the elevated roadway.

"I'm worried about being late."

"Worst case, we'll be fifteen minutes late. In my book, that's not late."

Jack glanced out the passenger-side window. Lou was right. Fifteen minutes fell into the appropriate time frame, but it didn't make him feel any less anxious.

"So, what's the occasion? You never said."

"Does there have to be an occasion?" Jack responded.

"All right already," Lou said, casting a quick glance in Jack's direction. His friend was acting out of character, but Lou let it drop. Something was up, but he wasn't about to push it.

They parked in a no-parking tow zone a few steps away from the restaurant's entrance. Lou tossed his police vehicle card onto the dashboard.

"You think this is going to be safe?" Jack questioned. "I don't want my bike getting towed along with your vehicle."

"They're not going to tow my car!" Lou said with conviction.

The two men walked into Elio's and entered the fray. The place was packed, particularly around the bar near the front door.

"Everybody is back from the Hamptons," Lou explained, practically yelling to be heard over the general din of voices and laughter.

Jack nodded, excused himself to those in front of him, and squeezed sideways deeper into the restaurant. People juggled their drinks as he brushed by. He was looking for the hostess, who he remembered as a soft-spoken, willowy woman with a kind smile. Before he could find her, someone tapped insistently on his shoulder. When he turned he found himself looking directly into Laurie's blue-green eyes. Jack could tell she had taken her "freshening up" quite seriously. Her luxurious auburn hair had been let out of her restrained, workaday French braid and cascaded to her shoulders. She was dressed in one of his favorite outfits: a white, high-collared, Victorian-style ruffled blouse with a honey-brown velvet jacket. In the half-light of the restaurant, her skin glowed as if illuminated from within.

To Jack she looked terrific, but there was a problem. Instead of the warm, fuzzy, happy expression he was expecting, she appeared more like amber and ice. Laurie seldom bothered to conceal her emotions. Jack knew something was wrong.

He apologized for being late, explaining how he'd been called out on a case, where he'd met Lou. Reaching behind him, Jack pulled Lou into their sphere of conversation. Lou and Laurie exchanged several cheek-to-cheek air kisses. Laurie responded by reaching behind her and drawing forward Warren Wilson and his longtime girlfriend, Natalie Adams. Warren was an intimidatingly well-muscled African American with whom Jack played basketball almost nightly. As a consequence, they had become close friends.

After greetings were exchanged, Jack yelled that he would find the hostess to inquire about their table. As he began pushing his way toward the hostess stand again, he sensed that Laurie was right behind him.

Jack stopped at the hostess's podium. Just beyond there was a clear buffer zone that separated the people dining from those standing around the bar. Jack caught sight of the hostess in the process of seating a dinner party. He turned back to Laurie to see if her expression had changed subsequent to his apology for being late.

"You weren't late," Laurie said, as if reading his mind. Although the comment was exonerating, the tone wasn't. "We had just got here a few minutes before you and Lou. It actually was good timing."

Jack studied Laurie's face. From the set of her jaw and the compression of her lips, it was clear she was still irritated, but he had no idea what was troubling her. "You look out of sorts. Is there something I should know?"

"I expected a romantic dinner," Laurie said. Her tone was now more wistful than angry. "You never told me you were inviting a horde."

"Warren, Natalie, and Lou are hardly a horde," Jack responded. "They are our best friends."

"Well, you could have and should have told me," Laurie responded. It didn't take long for her irritation to resurface. "I was obviously reading more into the evening than you intended."

Jack looked off for a moment to control his own emotions. After the anxiety and ambivalence he'd expended planning the evening, he was unprepared for negativism even if it was understandable. Obviously, he'd inadvertently hurt Laurie's feelings while being so absorbed in his own. The fact that she was counting on the two of them being alone hadn't even occurred to him.

"Don't roll your eyes at me!" Laurie snapped. "You could have been more communicative about what you had in mind for the evening. You know that I don't mind any time you want to go out with Warren and Lou."

Jack looked off in the other direction and bit his tongue to keep from lashing back. Luckily, he knew that if he did, the evening could well become unsalvageable. He took a deep breath, resolved to eat crow, and then locked eyes with Laurie. "I'm sorry," he said with all the sincerity he could muster under the circumstances. "It didn't occur to me you would take offense with it being sort of a dinner party. I should have been more up-front. To be honest, I invited the others for support."

Laurie's eyebrows pulled together in obvious confusion. "What kind of support? I don't understand."

"At the moment, it would be hard to explain," Jack said. "Could you give me a little slack for like a half-hour?"

"I suppose," Laurie said, still confused. "But I can't imagine what you mean by support. Yet I do appreciate your apology."

"Thank you," Jack said. He breathed out forcefully before looking back into the depths of the restaurant. "Now, where's that hostess and where's our table?"

It took another twenty minutes before the group was seated toward the rear of the dining room. By then, Laurie had seemingly forgotten her earlier pique and was acting as if she was enjoying herself, with easy laughter and animated conversation, although Jack felt she was avoiding looking at him. She was seated to his immediate right, so all he could see was her sculpted profile.

To Jack and Laurie's delight, the same handlebar-mustached waiter who'd waited on them during their prior dinners at Elio's appeared at their table. Most of those previous meals had been delightful, although some had been less so, yet still unforgettable. The last dinner, a year previously, had been in the latter category, and it had marked the nadir of their relationship, occurring during a month-long break from living together. It had been at that dinner that Laurie had revealed to Jack that she was pregnant, and Jack had had the insensitivity of flippantly asking who the father was. Although Jack and Laurie had subsequently patched up their relationship, the pregnancy had had to be terminated in short order. It had been a tubal ectopic pregnancy necessitating emergency surgery to save Laurie's life.

Seemingly on his own initiative, although actually on Jack's prior request, the waiter proceeded to distribute long-stemmed flutes. He then opened a bottle of champagne. The group cheered at the sonorous pop of the cork. The waiter then quickly filled everyone's glass.

"Hey, man," Warren said, holding up his bubbly. "To friendship."

Everyone followed suit, except Jack, who instead held up an empty hand. "If you don't mind, I'd like to say something right off the bat. You've all wondered why I've invited you here tonight, particularly Laurie. The fact of the matter is that I needed your support to go through with something I've wanted to do for some time, but have had trouble marshaling the courage. With that in mind, I'd like to make a toast that's rather selfish."

Jack thrust his hand into the side pocket of his jacket. With a struggle, he managed to extract a small, square box made of distinctive, shiny robin's-egg-blue paper and tied with a silver bow. He placed it on the table in front of Laurie and then lifted his glass. "I'd like to make a toast to Laurie and myself."

"All right!" Lou said happily and with emphasis. "To you guys." He raised his glass. The others did the same, except for Laurie.

"To you guys," Warren repeated.

"Here, here!" Natalie said.

Everyone took a drink, except Laurie, who was transfixed by the box in front of her. She thought she knew what was happening, but she couldn't believe it. She fought against her emotional side, which threatened to bubble to the surface.

"You're not going to participate in the toast?" Jack questioned her. Her immobility aroused an unwelcome doubt as to what he had thought her reaction would be. All of a sudden, he questioned what he would say and do if she refused.

With some difficulty, Laurie pulled her eyes away from the carefully wrapped box and locked onto Jack's. She thought she knew what was inside the tiny package but was afraid to admit it. She'd been wrong too many times in the past. As much as she loved Jack, she knew he labored under the strain of psychological baggage. There was no doubt he'd been severely traumatized by tragedy prior to their having met, and she had acclimatized herself to the chance he might never get over it.

"Hey, come on!" Lou urged. "What the hell is it? Open it up."

"Yeah, come on, Laurie," Warren urged.

"Am I supposed to open it now?" Laurie questioned. Her eyes were still locked onto Jack's.

"That was the general idea," Jack said. "Of course, if you prefer, you can wait a couple more years. I don't mean to put any pressure on you."

Laurie smiled. Occasionally, she found Jack's sarcasm humorous. With trembling fingers, she removed first the tie and then the wrapping from the package. Everyone but Jack leaned forward with anticipation. The underlying box was covered with black crushed velvet. With the trepidation that Jack might be playing an elaborate and inappropriate trick on her, she snapped open the box. Gleaming back at her was a Tiffany solitaire diamond. It sparkled with what appeared to be an inner light.

She turned the box around so the others could see while she shut her eyes and fought against tears. Such emotionalism was a personality trait she despised in herself, although under the present circumstances, even she could understand it. She and Jack had been dating for almost a decade and living with each other on and off for years. She'd wanted to marry, and she had been convinced he felt similarly.

There were a series of oohs and ahhs from Lou, Warren, and Natalie.

"Well?" Jack questioned Laurie.

Laurie struggled to get herself under control. She used a knuckle to wipe away a tear from each eye. She looked up at Jack and made an instantaneous decision to turn the tables on him and pretend she didn't know what he was implying. It was something Jack could very well have done. After all these years, she wanted to hear him actually say what the engagement ring implied. "Well what?" she questioned.

"It's an engagement ring!" Jack said with a short, self-conscious laugh.

"I know what it is," Laurie responded. "But what does it mean?" She was pleased. Putting pressure on Jack had the benefit of keeping her own emotions in check. A slight smile even appeared at the corners of her mouth as she watched him squirm.

"Be specific, you ass!" Lou barked at Jack. "Pop the question!"

Jack realized what Laurie had done, and a smile came to his face as well. "All right, all right!" he said, quieting Lou. "Laurie, my love, despite the danger in the past that has befallen those I love and hold dear and my fear such danger could extend to you, would you marry me?"

"That's more like it!" Lou said, holding his glass again in the air. "I propose a toast to Jack's proposal."

This time everyone drank.

"Well?" Jack repeated, redirecting attention to Laurie.

Laurie thought for a moment before answering. "I know your fears and understand their origin. I just don't share them. Be that as it may, I fully accept the risk, whether real or imagined. If something is to happen to me, it will be my fault entirely. With that caveat, yes, I would love to marry you."

Everyone cheered as Jack and Laurie exchanged a self-conscious kiss and awkward hug. Laurie then took the ring from the box and tried it on. She extended her hand to look at it. "It fits perfectly. It's exquisite!"

"I borrowed one of your rings for a day to be sure of the size," Jack admitted.

"Not the biggest rock in the world," Lou said. "Did it come with a magnifying glass?"

Jack threw his napkin at Lou, who caught it before it wrapped around his face.

"Your best friends are always honest." Lou laughed. He handed the napkin back.

"It's a perfect size," Laurie said. "I don't like jewelry to be gaudy."

"You got your wish," Lou added. "No one is going to call it gaudy."

"When will the big day be?" Natalie asked.

Jack looked at Laurie. "Obviously, we haven't talked about it, but I think I'll leave it up to Laurie."

"Really?" Laurie questioned.

"Really," Jack answered.

"Then I'd like to talk to my mom about the timing. She's let me know on many an occasion in the past that she'd like me to have my wedding at the Riverside Church. I know that was where she had wanted to be married herself, but it didn't happen. If it's all right, I'd like her to have a say as to the timing and the place."

"Fine by me," Jack said. "Now where's that waiter? I need some more champagne."

Boston, Massachusetts October 9, 2005 4:45 p.m.

(one month later)

It had been a great workout. Craig Bowman had used the weight room for a half-hour to tone up and stretch. Then he'd gotten into a series of competitive, pickup, three-on-three basketball games. By pure luck, he'd managed to be teamed up with two talented players. For well over an hour, he and his teammates had not lost and had given up the court only from sheer exhaustion. After the basketball, Craig had indulged himself with a massage followed by a steam and shower.

Now, as Craig stood in front of the mirror in the VIP section of the Sports Club/LA men's locker room and regarded himself critically, he had to admit he looked better than he had in years. He'd lost twenty-two pounds and an inch from his waist since he'd joined the club six months ago. Perhaps even more apparent was the disappearance of the pudgy sallowness of his cheeks. In its place was a healthy, rosy glow. As an attempt to appear more contemporary, he'd let his sandy-colored hair grow out a bit, and then had it styled at a salon such that he now brushed it back on both sides rather than parting it on the left as he'd done for as long as he could remember. From his perspective, the overall change was so remarkable that had he seen himself a year ago he wouldn't have recognized himself. He surely was no longer the stodgy, bromidic doctor.

Craig's current routine was to come to the club three times a week: Monday, Wednesday, and Friday. Of the three days, Friday was the best, since it was the least crowded and afforded the psychological stimulus of the weekend stretching out in front of him with all its promise. As a standing policy, he'd decided to close the office at noon on Fridays and take calls with his cell phone. That way, Leona could come with him to work out. As a present for her as well as himself, he'd sprung for a second membership.

Several weeks previously, Leona had moved in with him at his Beacon Hill home. She'd decided on her own that it was ridiculous for her to pay for an apartment in Somerville when she was staying with him every night. Craig initially had been miffed about the move, because there had been no discussion and it had been presented as a fait accompli. To him it seemed coercive just when he was reveling in his new freedom. But, after a few days, he had adjusted. He had forgotten the power of eroticism. Also, he rationalized that the living arrangement could be reversed with ease if the need arose.

Craig's final preparation was to slip on his new Brioni jacket. After shrugging his shoulders a few times to settle it into place, he glanced back into the mirror. Turning his head from side to side to view himself from slightly different angles, he briefly entertained the idea of studying acting instead of art. The notion brought a smile to his face. He knew his imagination was running wild yet the thought was not completely preposterous. As well as things were going, he couldn't help feel that the world was his oyster.

When Craig was fully dressed, he checked his cell phone for messages. He was in the clear. The plan was to head back to the apartment, relax with a glass of wine and the newest New England Journal of Medicine for an hour or so, then on to the Museum of Fine Arts to check out the current exhibition, and finally go to dinner at a new, trendy restaurant in the Back Bay.

Whistling under his breath, Craig walked from the locker room out into the main lobby of the club. To his left was the sign-in desk, while to his right down a corridor past the bank of elevators were the bar and restaurant. Muted music could be heard from the general area. Although the athletic facilities were generally not crowded on Friday afternoons, happy hour at the bar was another story and was just beginning to gear up.

Craig checked his watch. He'd timed things perfectly. It was quarter to five: the exact time he'd agreed to meet Leona. Although they came to the club and left together, while they were there, they each did their own thing. Leona was currently into the stair machine, Pilates, and yoga, none of which thrilled Craig.

A quick visual sweep of the sitting area confirmed that Leona had yet to emerge from the women's side. Craig wasn't surprised. Along with a relative lack of reserve, punctuality was not one of her strong points. He took a seat, perfectly content to watch the parade of attractive people coming and going. Six months ago, in a similar circumstance he would have felt like the odd man out. Now he felt entirely at ease, but no sooner had he gotten comfortable than Leona appeared, coming through the women's locker room door.

Just as he had critically regarded himself a few minutes earlier, Craig gave Leona a quick once-over. The workouts were benefiting her as well, though, due to her comparative youth, she'd been firm, rosy-cheeked, and shapely from the start. As she drew near, he could appreciate that she was an attractive as well as a high-spirited and headstrong young woman. Her main handicap from Craig's perspective was her Revere, Massachusetts, accent and syntax. Particularly grating was her tendency to pronounce every word ending in an "er" as if it ended in a short but harsh "a." Believing he had her interests at heart, Craig had tried to call her attention to her habit with the hope of getting her to change, but she'd reacted angrily, venomously accusing him of being an Ivy League elitist. So Craig had wisely given up. Over time, his ear had acclimated to a degree, and in the heat of the night he really didn't care whether she had an accent.

"How was your workout?" Craig asked, getting to his feet.

"Terrific," Leona responded. "Better than usual."

Craig winced. The accent on terrific was on the first syllable instead of the second, and better came out as "beddah." As they walked to the elevator, he resisted the urge to comment by tuning her out. While she carried on about her workout and why he should try both Pilates and yoga, he contentedly mused about the upcoming evening and what a pleasant day it had been so far. That morning at the office he'd seen twelve patients: not too many and not too few. There had been no rushing frantically from one exam room to another, which was the usual course of events at his old practice.

Over the months he and Marlene, his matronly main secretary and receptionist, had developed a system of scheduling patients according to each patient's need, based on the diagnosis and the individual's personality. The shortest visits were fifteen minutes for rapid, return-visit checkups with compliant and knowledgeable patients, and the longest was one and a half hours. The hour-plus visits were generally for new patients with known and serious medical problems. Healthy new patients were scheduled from forty-five minutes to one hour, depending on age and seriousness of the complaints. If an unexpected problem developed during the course of the day, such as an unscheduled patient needing to be seen or Craig having to go over to the hospital, which hadn't happened that day, Marlene would call the upcoming patients to reschedule if possible and appropriate.

As a consequence, it was rare for people to wait in Craig's office, and equally rare for him to suffer the anxiety of being behind and trying to catch up. It was a civilized way to practice medicine and far better for everyone. Nowadays, Craig actually liked going to the office. It was the kind of medicine he'd imagined when he'd dreamed of becoming a doctor. The only slight bugaboo in what was otherwise a near-perfect situation was that it had not been possible to keep all aspects of his relationship with Leona a secret. Suspicions were rampant and made worse by Leona's youth and willfulness. Consequently Craig had to weather an undercurrent of disapproval from Marlene and his nurse, Darlene, as well as observe their resentful and passive-aggressive behavior toward Leona.

"You're not listening to me!" Leona complained irritably. She leaned forward to glare at Craig. Both had been facing the elevator doors as they descended to the parking garage.

"Of course I am," Craig lied. He smiled, but Leona's mercurial petulance wasn't assuaged.

The elevator doors opened on the valet-parking floor, and Leona stalked out to join a half-dozen people waiting for their vehicles. Craig followed a few steps behind. Relatively wide swings of emotion were a trait of Leona's that Craig was not fond of, but they were generally quick if he just ignored them. Had he slipped a few minutes earlier up in the lobby and called attention to her accent, it would have been a different story. The previous and only time he'd made such a comment had caused a two-day snit.

Craig gave his parking stub to one of the attendants.

"Red Porsche coming right up, Dr. Bowman," the attendant said while touching the peak of his cap with his index finger in a form of salute. He sprinted away.

Craig smiled inwardly. He was proud that he had what he considered the sexiest car in the garage and the antithesis of the Volvo station wagon he'd had in his previous life. Craig imagined that those waiting around him for their cars would be duly impressed. The parking attendants obviously were impressed, as evidenced by their always parking his vehicle close to the valet stand.

"If I seem a little distant," Craig whispered to Leona, "it's because I'm looking forward to our evening: all of it." He winked suggestively.

Leona regarded him with one eyebrow raised, indicating she was only partially placated. The reality was that she demanded full attention a hundred percent of the time.

At the same moment that Craig heard the familiar whine and roar of his car engine starting somewhere nearby, he also heard his name called out from behind him. What caught his attention particularly was that his middle initial, M, had been included. Few people knew his middle initial, and fewer still knew that it stood for Mason, his mother's maiden name. Craig turned, expecting to see a patient or perhaps a colleague or an old schoolmate. Instead, he saw a stranger approach. The man was a handsome African American, quick-moving, intelligent-appearing, and approximately Craig's age. For a moment, Craig thought he was a teammate from that afternoon's three-on-three basketball marathon who wanted to gloat anew over that afternoon's victories.

"Doctor Craig M. Bowman?" the man questioned again as he stepped directly up to Craig.

"Yes?" Craig said with a questioning nod. He was still trying to place the individual. He wasn't one of the basketball players. Nor was he a patient or a schoolmate. Craig tried to associate him with the hospital, but he couldn't.

The man responded by placing a large, sealed envelope in Craig's hand. Craig looked at it. His name along with his middle initial was typed on the front. Before Craig could respond, the man turned on his heel and managed to catch the elevator he'd arrived in before the doors had had a chance to close. The man was gone. The transaction had taken only seconds.

"What'd you get?" Leona asked.

"I haven't the slightest idea," Craig said. He looked back down at the envelope and got his first inkling of trouble. Printed in the upper corner was: Superior Court, Suffolk County, Massachusetts.

"Well?" Leona questioned. "Aren't you going to open it?"

"I'm not sure I want to," Craig said, although he knew he would have to sooner or later. Craig's eyes scanned the people grouped around him, waiting for their cars. A number were curiously looking at him after having witnessed the encounter.

As the valet pulled Craig's Porsche up to the stand and got out, holding the driver's-side door ajar, Craig worked his thumb under the envelope's flap and tore it open. He could feel his pulse quicken as he pulled out the contents. He was holding a dog-eared sheaf of papers stapled together.

"Well?" Leona repeated with concern. She could see Craig's exercise-induced ruddiness perceptively fade.

Craig's eyes lifted and locked onto Leona's. They reflected an intensity Leona had not seen. She couldn't tell if it was from confusion or disbelief, yet it was clearly shock. For a few beats, Craig seemed paralyzed. He didn't even breathe.

"Hello?" Leona called questioningly. "Anybody home?" She waved a hand in front of Craig's marmoreal face. A furtive glance told her that they had become the object of everyone's attention.

As if he were waking from a petit mal seizure, Craig's pupils narrowed and color rapidly re-suffused his face. His hands began to reflexively crumple the papers before rationality intervened.

"I've been served," Craig croaked in a whisper. "The bastard is suing me!" He straightened the papers and rapidly flipped through them.

"Who is suing?"

"Stanhope! Jordan Stanhope!"

"What for?"

"Medical malpractice and wrongful death. This is outrageous!"

"Concerning Patience Stanhope?"

"Who else?" Craig demanded viciously through clenched teeth. "Hey, I'm not the enemy," Leona said, raising her hands in mock defense.

"I cannot believe this! This is an outrage!" Craig shuffled through the papers again, as if perhaps he'd misread them.

Leona glanced over to the valets. A second attendant had opened the passenger door for her. The first was still holding open the driver's-side door. Leona looked back at Craig. "What do you want to do, Craigie?" she whispered insistently. "We can't stand here forever." Forever came out as "forevah."

"Shut up!" Craig barked. Her accent grated against his raw nerves.

Leona let out a suppressed, mockingly aggrieved laugh, then warned: "Don't you dare talk to me like that!"

As if waking a second time and becoming aware that all eyes were on them, Craig apologized under his breath, then added: "I need a drink."

"Okay," Leona agreed, still miffed. "Where? Here or at home?"

"Here!" Craig snapped. He turned and headed back to the elevators.

With an apologetic smile and shrug for the benefit of the valets, Leona followed Craig. When she got to him, he was repeatedly punching the elevator button with a knuckle. "You have to calm down," she told him. She looked back at the group. People quickly averted their gaze to pretend they had not been watching.

"It's easy for you to say to calm down," Craig shot back. "You're not the one being sued. And getting served like this in public is goddamn humiliating."

Leona didn't try to make conversation again until they were seated at a small but tall table apart as much as possible from the happy-hour crowd. The chairs were barstools with low backs, which accounted for the table height. Craig had a double scotch, which was hardly customary for him. Normally, he drank sparingly for fear of being called professionally at any given hour. Leona had a glass of white wine. She could tell from how he shakily handled his drink that his mind-set had transformed yet again. He'd gone from the initial shocked disbelief to anger and now to anxiety, all within the fifteen minutes since he'd been handed the summons and the complaint.

"I've never seen you so upset," Leona offered. Although she didn't quite know what to say, she felt she needed to say something. She was never good at silence unless it was on her terms as a purposeful pout.

"Of course I'm upset," Craig snapped. As he raised his drink, he was shaking enough to cause the ice to clink repeatedly against the glass. When he got it to his lips, he managed to slosh scotch over the rim. "Shit," he said as he put the glass back down and shook the scotch from his hand. He then used the cocktail napkin to wipe his lips and chin. "I cannot believe this oddball bastard Jordan Stanhope would do this to me, especially after all the time and energy I've squandered on his hypochrondriacal, clingy excuse for a wife. I hated that woman."

Craig hesitated for a moment, then added: "I suppose I shouldn't be telling you this. It's the kind of thing doctors don't talk about."

"I think you should talk about it, seeing how upset you are."

"The truth is that Patience Stanhope drove me crazy with her disgusting rehash over and over of every damn bowel movement she ever had, and that was on top of the graphic descriptions of greenish-yellow, gloppy phlegm she coughed up on a daily basis and even saved to show me. It was pathetic. She drove everybody crazy, including Jordan and even herself, for Christ's sake."

Leona nodded. Although psychology was not one of her strengths, she felt it was important to let Craig rail on.

"I can't tell you how many times over the last year I had to drive out there after work or even in the middle of the night to that huge house of theirs to hold her hand and listen to her carry on. And for what? She rarely followed through with anything I suggested, including stopping her smoking. She smoked like a fiend, no matter what I said."

"Really?" Leona questioned, unable to contain herself. "She carried on about coughing up phlegm and continued to smoke?"

"Don't you remember how her bedroom reeked of cigarette smoke?"

"Not really" Leona said with a shake of her head. "I was too taken by the situation to smell anything."

"She smoked like there was no tomorrow, one cigarette after another, going through several packs a day. And that was just a part of it. I'm telling you, she was the poster woman for all the non-compliant patients of the world, especially concerning medication. She demanded prescriptions and then took the drugs or didn't take them according to her whim."

"Did you have any idea why she didn't follow orders?"

"Probably because she liked being sick. It gave her something to do. That's the long and short of it. She was a waste of time for me, for her husband, even for herself. Her passing was a blessing for everyone. She didn't have a life."

Craig had calmed down enough to take a drink of his scotch without spilling any.

"I remember from the few times I had contact with her in the office, she seemed like a piece of work," Leona said placatingly.

"That's the understatement of the year," Craig grumbled. "She was an entitled bitch with some inherited money, meaning she expected me to hold her hand and listen to her complaints ad nauseam. I struggled through four years of college, four years of medical school, five years of residency, board certification, and authored a handful of scientific papers, and all she wanted was for me to hold her hand. That was it, and if I held it for fifteen minutes, she wanted thirty, and if I gave her thirty, she wanted forty-five, and if I refused, she became sulky and hostile."

"Maybe she was lonely," Leona suggested.

"Whose side are you on?" Craig demanded angrily. He slapped his drink down onto the table, clanking the ice cubes. "She was a pain in the ass."

"Geez, relax already!" Leona urged. She glanced around selfconsciously and was relieved to see that no one was paying them the slightest attention.

"Just don't start playing devil's advocate," Craig snapped. "I'm not in the mood."

"I'm only trying to get you to calm down."

"How can I calm down? This is a disaster. I've worked all my life to be the best doctor. Hell, I'm still working at it. And now this!" Craig angrily slapped the envelope containing the legal papers.

"But isn't this the reason you pay the malpractice insurance you complain about?"

Craig eyed Leona with exasperation. "I don't think you understand. This screwball Stanhope is publicly defaming me by demanding his, quote, day in court. The process is the problem. It's bad no matter what happens. I'm helpless, a victim. And if you go to trial, who knows how it will turn out. There are no guarantees, even in my situation, where I've been bending over backward for my patients, particularly Patience Stanhope, making house calls for crying out loud. And the idea it would be a trial by my peers? That's a bad joke. File clerks, plumbers, and retired schoolteachers have no idea what it's like being a doctor like me, getting up in the middle of the night to hold hypochondriacs' hands. Jesus H. Christ!"

"Can't you tell them? Make it part of your testimony."

Craig rolled his eyes with exasperation. There were occasions when Leona drove him batty. It was the downside of spending time with someone so young and inexperienced.

"Why does he think there was malpractice?" Leona asked.

Craig looked off at the normal, beautiful people around the bar, obviously enjoying the evening with their happy banter. The juxtaposition made him feel worse. Maybe coming up to the public bar was a bad idea. The thought went through his mind that perhaps becoming one of them through his cultural endeavors was really beyond his grasp. Medicine and its current problems, including the malpractice mess, had him ensnared.

"What malpractice was there supposed to have been?" Leona asked, rephrasing her question.

Craig threw up his hands. "Listen, bright eyes! It's generic on the complaint, saying something about me not using the skill and care in making a diagnosis and treatment that a reasonable, competent doctor would employ in the same circumstance… blah blah blah. It's all bullshit. The long and short is that there was a bad outcome, meaning Patience Stanhope died. A personal injury-malpractice lawyer will just go from there and be creative. Those guys can always find something that some asshole, courthouse-whore doctor will say should have been done differently."

"Bright eyes!" Leona snapped back. "Don't be condescending to me!"

"Okay, I'm sorry," Craig said. He took a deep breath. "Obviously, I'm out of sorts."

"What's a courthouse-whore doctor?"

"It's a doctor who hires himself or herself out to be a, quote, expert and who will say whatever the plaintiff attorney wants him to say. It used to be hard to find doctors to testify against doctors, but not anymore. There are some worthless bastards that make a living doing it."

"That's terrible."

"It's the least of it," Craig said. He shook his head dejectedly. "It's mighty hypocritical that this screwball Jordan Stanhope is suing me when he didn't even stay around at the hospital while I was struggling to revive his pathetic wife. Hell, on a number of occasions he confided with me that his wife was a hopeless hypochondriac and that he couldn't keep all her symptoms straight. He was even apologetic when she'd have him call and insist I come to the house at three in the morning because she thought she was dying. That really happened on more than one occasion. Usually the house calls were in the evenings, forcing me to interrupt what I was doing. But even then, Jordan would always thank me, so he knew what kind of effort it was, coming out there for no good reason. The woman was a disaster. Everyone is better off with her out of the picture, including Jordan Stanhope, yet he is suing me and claiming damages of five million dollars for loss of consortium. What a cruel joke." Craig shook his head dejectedly.

"What's consortium?"

"What someone is supposed to get from a spouse. You know: company, affection, assistance, and sex."

"I don't think they were having much sex. They had separate bedrooms!"

"You probably have that right. I can't imagine he'd want to or even be able to have sex with that miserable hag."

"Do you think the reason he's suing you might have something to do with you criticizing him that night? He did seem to take offense."

Craig nodded a few times. Leona had a point. With glass in hand, he slipped off the barstool and returned to the bar for a refill. As he waited among the happy revelers, he thought about Leona's idea and wondered if she was correct. He remembered regretting what he had said to Jordan when he'd gotten into Patience's bedroom and saw how bad off she was. His comment had just popped out of his mouth in the stress of the circumstances and how surprised he'd been. At the time, he'd thought his hasty apology had been sufficient, but maybe not. If not, he was going to regret the incident even more.

With a second double scotch, Craig worked his way back to the table and got himself onto his barstool. He moved slowly, as if his legs weighed a hundred pounds apiece. To Leona he seemed to have made yet another transition. He now appeared depressed, his mouth slack and his eyes droopy.

"This is a disaster," Craig managed with a sigh. He stared down into his scotch, his arms folded on the table. "This could be the end of everything, just when things are going so well."

"How can it be the end of everything?" Leona asked, trying to be lively. "What are you supposed to do now that you have been served?"

Craig didn't answer. He didn't even move. Leona couldn't even see him breathing.

"Shouldn't you get a lawyer?" Leona persisted. She leaned forward in an attempt to look up into Craig's face.

"The insurance company is supposed to defend me," Craig responded in a flat voice.

"Well, there you go. Why not call them?"

Craig raised his eyes and met Leona's. He nodded a few times as he gave Leona's suggestion consideration. It was almost five thirty on a Friday night, yet the insurance company might have someone on call. It was worth a try. He could use the reassurance that he was at least doing something. A big part of his anxiety was from the helplessness he felt in the face of such an overwhelming, disembodied threat.

With newly found urgency, Craig snapped his cell phone from its clip on his belt. Using klutzy fingers, he scrolled through his address book. Like a beacon in a dark night, the name and cell phone number of his insurance agent popped into view. Craig made the call.

It ended up requiring several calls, including having to leave his name and number in an emergency voicemail, but within a quarter of an hour, Craig was able to tell his story to a real person with an authoritative voice who acted calmly knowledgeable. His name was Arthur Marshall, the sound of which Craig found curiously reassuring.

"Since this is your first brush with this kind of event," Arthur was saying, "and since we know from experience how uniquely unsettling it is, I think it is important for you to understand that for us it is all too common. In other words, we are experienced in dealing with malpractice litigation, and we will give your case all the attention it deserves. Meanwhile, I want to emphasize that you should not take it personally."

"How else can I take it?" Craig complained. "It's calling into question my life's work. It's putting everything in jeopardy."

"That is a common feeling for someone like yourself and entirely understandable. But trust me, it is not like that! It is not a reflection of your dedication and life's work. More often than not, it is a fishing expedition in hopes of a financial windfall despite the plaintiff attorney's claims to the contrary. Everyone familiar with medicine knows that less-than-perfect outcomes, even involving honest mistakes, are not malpractice, and the judge will so advise the jury if this action were to go to a trial. But remember! The vast majority of such cases do not go to trial, or if they do, the vast majority are won by the defense. Here in Massachusetts, by statute your claim must go before a tribunal, and with the facts you've given me, it probably will stop there."

Craig's pulse had come down to a nearly normal level.

"You're wise to have contacted us so early in the course of this unfortunate affair, Dr. Bowman. In short order, we will assign a skilled, experienced attorney to the case, and for that we will need to get the summons and the complaint ASAP. You are required to answer within thirty days of service."

"I can messenger this material on Monday."

"That will be perfect. Meanwhile, let me suggest you begin to refresh your mind about the case, particularly by getting your records together. It's something that has to be done, and it will give you the feeling you are doing something constructive to protect yourself. From our experience, we know that is important."

Craig found himself nodding in agreement.

"In regard to your records, Dr. Bowman, I must warn you not to change them in any way or form. That means do not change a misspelled word or an obvious grammatical error or something you might feel is sloppy. Do not change any dates. In short, do not change a thing. Do you understand?"

"Absolutely."

"Good! Of those malpractice cases found for the plaintiff, a sizable number involved some editing of the records, even if the editing was entirely inconsequential. Any alteration is a recipe for disaster, since it impugns your integrity and truthfulness. I hope I'm making myself clear."

"Perfectly clear. Thank you, Mr. Marshall. I'm feeling a bit better."

"And indeed you should, doctor. Rest assured, we will be giving your case our full attention since all of us want to bring it to a speedy, successful conclusion so that you can get back to what you do best: taking care of your patients."

"I'd like nothing better."

"We are at your service, Dr. Bowman. One last issue, of which I'm sure you are already cognizant. Do not… I repeat… do not discuss this matter with anyone accept your spouse and the attorney we assign! This extends to all colleagues, acquaintances, and even close friends. This is very important."

Craig looked guiltily across the table at Leona, realizing how much he'd been inappropriately babbling. "Close friends?" Craig questioned. "That means possibly having to forgo emotional support."

"We recognize that, but the downside is worse."

"And what exactly is the downside?" He wasn't sure how much of the incoming conversation Leona could hear. She was watching him intently.

"Because friends and colleagues are discoverable. Plaintiff attorneys can and do, if it serves their interests, force friends, even close friends, and colleagues to be witnesses, often to great effect."

"I'll keep that in mind," Craig said. "Thank you for your admonitions, Mr. Marshall." Craig's pulse had quickened again. Being honest with himself, he had to admit that he really didn't know Leona beyond her youthful and understandable self-centeredness. Having been so talkative added to his anxiety.

"And thank you, Dr. Bowman. We will be in touch as soon as we get the summons and the complaint. Try to relax and go about your life."

"I'll try," Craig said without a lot of conviction. He knew he was going to be living under a dark cloud until all was settled. What he didn't know was how dark it was going to get. In the meantime, he vowed to avoid calling attention to Leona's accent. He was smart enough to know that what he had confided about his feelings toward Patience Stanhope would not play well in a court of law.

New York, New York October 9, 2005 4:45 p.m.

Jack Stapleton turned his attention to the heart and the lungs. In front of him spread out on the autopsy table was the naked, gutted remains of a white, fifty-seven-year-old female. The victim's head was propped up on a wooden block, and her unseeing eyes stared blankly at the overhead fluorescent lights. Up until that point in the postmortem, there had been little pathology save for a rather large, apparently asymptomatic uterine fibroid. Specifically, there had been nothing as yet to account for the death of an apparently healthy woman who had collapsed in Bloomingdale's. Miguel Sanchez, the evening mortuary technician who'd come in at 3:00 p.m. to start his day, was assisting. While Jack prepared to examine the heart and lungs, Miguel was busy at the sink, washing out the intestines.

By merely palpating the surface of the lungs, Jack's experienced hands perceived an abnormal resistance. The tissue was firmer than usual, which was consistent with the organ's weight being higher than normal. With a knife that looked like a garden-variety butcher knife, Jack made multiple slices into the lung. Again, there was the suggestion of more resistance than he would expect. Lifting the lung, he examined the cut surfaces, which reflected the organ's consistency. The lung appeared denser than normal, and he was confident that the microscopic would show fibrosis. The question was… why were the lungs fibrotic?

Turning his attention to the heart, Jack picked up toothed forceps and a pair of small, blunt-nosed scissors. Just when he was about to begin work on the muscular organ, the door to the hallway opened. Jack hesitated as a figure appeared and approached. It took only a moment for him to recognize Laurie despite the light reflecting off her plastic face mask.

"I was wondering where you were," Laurie said with a hint of exasperation. She was dressed in full-body disposable Tyvek protective gear, as were Jack and Miguel. It was a standing order by Dr. Calvin Washington, the deputy chief medical examiner, to wear such an outfit for protection against potential infectious agents when in the autopsy room. One never knew what kind of microbes might be encountered, especially in an autopsy room as busy as the one in New York City.

"Wondering where I was suggests you were looking for me."

"Brilliant deduction," Laurie said. She glanced down at the ghostly pale human shell on the table. "This was the last place I thought to look for you. Why such a late post?"

"You know me," Jack quipped. "I have no restraint whatsoever when an opportunity to have fun knocks on my door."

"Anything interesting?" Laurie said, immune to Jack's sarcastic humor. She reached out and touched the surface of the cut lung with her gloved index finger.

"Not yet, but I think I'm about to hit pay dirt. You can see that the lung appears fibrotic. I believe the heart's going to tell us why."

"What's the background of the case?"

"The victim was given the price of a pair of Jimmy Choo shoes in Bloomie's and arrested."

"Very funny."

"Seriously, she did arrest in Bloomingdale's. Of course, I don't know what she was doing. Apparently, the store staff and a Good Samaritan doctor who happened to be on the scene attended to her immediately. They started CPR, and it was continued in the ambulance all the way over to the Manhattan General. When the body arrived over here at the OCME, the head doc in the ER called to give me the story. He said that no matter what they did in the ER, they couldn't get so much as a single beat out of the heart, even with a pacemaker. As chagrined as they were that the patient was so uncooperative as to not revive, he was hoping we could shed some light in case there was something else that could have been done. I was impressed with his interest and initiative, and since that is the kind of professional behavior we should be encouraging, I told him I'd do the case straight off and get right back to him."

"Very commendable and industrious on your part," Laurie said. "Of course, doing an autopsy at this hour, you're making the rest of us look like slackers."

"If it looks like a duck, quacks like a duck, it's a duck!"

"Okay, wise guy! I'm not going to try to compete with your repartee. Let's see what you got! You've got my interest, so go for it."

Jack bent over, quickly but carefully traced the major coronary arteries, and then proceeded to open them. Suddenly, he straightened up. "Well, lookie here!" he said. He picked up the heart and held it so Laurie could see more easily. He pointed with the tip of his forceps.

"Good grief," Laurie exclaimed. "That might be the most dramatic narrowing of the main trunk of the posterior descending artery I've ever seen. And it looks developmental, not atheromatous."

"That would be my take as well, and it probably explains the unresponsive heart. A sudden, even transient, blockage would have caused a massive heart attack involving parts of the conduction system. I imagine the entire posterior side of the heart was involved in the infarction. But as dramatic as it is, it doesn't explain the pulmonary changes."

"Why don't you open the heart?"

"That was exactly my intention."

Exchanging the scissors and forceps for the butcher knife, Jack made a series of cuts into the heart's chambers. "Voila!" he said, leaning out of the way so Laurie could see the splayed organ.

"There you go: a damaged, incompetent mitral valve!"

"A very incompetent mitral valve. This woman was a walking time bomb waiting to explode. It's amazing she didn't have symptoms from either the coronary narrowing or the valve to drive her to a physician. It's also too bad. Both problems were surgically correctable."

"Fear often makes some people sadly stoic."

"You've got that right," Jack said as he started taking samples for microscopic examination. He put them into appropriately labeled bottles. "You still haven't told me why you were looking for me."

"An hour ago I got some news. We now have a wedding date. I was eager to run it by you, because I have to get back to them as soon as possible."

Jack paused in what he was doing. Even Miguel at the sink stopped rinsing out the intestines.

"This is a curious environment for such an announcement," Jack said.

Laurie shrugged. "It's where I found you. I was hoping to call back this afternoon before the weekend."

Jack briefly glanced over at Miguel. "What's the date?"

"June ninth at one thirty. What do you think?"

Jack chuckled. "What am I supposed to think? It seems a long time off now that we have finally decided to go through with it. I was kind of thinking about next Tuesday."

Laurie laughed. The sound was muffled by her plastic face screen, which briefly fogged up. "That's a sweet thing to say. But the reality is that my mother has always anticipated a June wedding. I personally think June is a great month because the weather should be good, not only for the wedding but also for a honeymoon."

"Then it's okay with me," Jack said, casting a second quick look in Miguel's direction. It was bothering him that Miguel was just standing there, not moving and obviously listening.

"There is only one problem. June is so popular for weddings that the Riverside Church is already booked for all the Saturdays in the month. Can you imagine, eight months in advance. Anyway, June ninth is a Friday. Does that bother you?"

"Friday, Saturday – it doesn't matter to me. I'm easy."

"Fabulous. Actually, I'd prefer Saturday because it's traditional and easier for guests, but the reality is that the option's not available."

"Hey, Miguel!" Jack called. "How about finishing with those intestines. Let's not make it your life's work."

"I'm all done, Dr. Stapleton. I'm just waiting for you to come on over and take a peek."

"Oh!" Jack said simply, mildly embarrassed for assuming the tech was eavesdropping. Then to Laurie he said, "Sorry, but I have to keep this show on the road."

"No problem," Laurie said. She trailed after him over to the sink.

Miguel handed over the intestines, which had been opened throughout their length and then thoroughly rinsed to expose the mucosal surface.

"There's something else I found out today," Laurie said. "And I wanted to share it with you."

"Go ahead," Jack said as he methodically began to examine the digestive system, starting from the esophagus and working southward.

"You know, I've never felt particularly comfortable in your apartment, mainly because the building is a pigsty." Jack lived in a fourth-floor walk-up unit in a dilapidated building on 106th Street just opposite the neighborhood playground he had paid to have completely reconditioned. Stemming from a persistent belief that he didn't deserve to be comfortable, he lived significantly below his means. Laurie's presence, however, had altered the equation.

"I don't mean to hurt your feelings about this," Laurie continued. "But with the wedding coming up, we have to give some thought to our living situation. So I took the liberty of looking into who actually owns the property, which the supposed management company where you send your checks was reluctant to divulge. Anyway, I found out who owns it and contacted them to see if they would be interested in selling. Guess what? They are, as long as it's purchased in its 'as is' condition. I think that raises some interesting possibilities. What do you think?"

Jack had stopped examining the guts in his hands as Laurie spoke, and he now turned to her. "Wedding plans over the autopsy table, and now hearth-and-home issues over the intestinal sink. Don't you think this might not be the best place for this discussion?"

"I just learned about this minutes ago, and I was excited to tell you so you could start mulling it over."

"Terrific," Jack said, suppressing an almost irresistible urge to be more sarcastic. " Mission accomplished. But what do you say to the idea we discuss buying and, I assume, renovating a house over a glass of wine and an arugula salad in a slightly more appropriate setting?"

"That's a marvelous idea," Laurie said happily. "See you back at the apartment."

With that said, Laurie turned on her heels and was gone.

Jack continued to stare at the door to the hall for several beats after it had closed behind her.

"It's great you guys are getting married," Miguel said to break the silence.

"Thank you. It's not a secret, but it's not common knowledge, either. I hope you can respect that."

"No problem, Dr. Stapleton. But I have to tell you from experience that getting married changes everything."

"How right you are," Jack said. He knew that from experience as well.