"Fatal Cure" - читать интересную книгу автора (Cook Robin)

1

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

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

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

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

"What's so funny?" Nikki demanded indignantly.

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

"Why did you laugh?" Nikki persisted.

"Ask your mother," David said.

"No, I think your father should explain."

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

"We're on Highway 89," David said.

"I know!" Nikki said with annoyance. "I don't want any help."

"Excuse me," David said with a smile.

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

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

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

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

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

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

"Are we going to see mountains?" Nikki asked.

"We sure are," David said. "The Green Mountains."

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

"Are we in Vermont now?" Angela asked,

"Yes, Mom!" Nikki said with impatience.

"How much further to Bartlet?" Angela asked.

"I'm not quite sure," David said. "Maybe an hour."

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

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

"So far it looks story-bookish," Angela said.

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

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

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

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

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

"What's that?" Nikki questioned. "It looks like a trolley with no wheels."

David laughed. "That's called a diner," he said. "They were popular back in the fifties."

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

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

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

"Like father, like daughter," Angela said.

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

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

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

"We've got several hours before our interviews. What do you think we should do?" David asked.

"Why don't we drive around a little more, then have lunch?" Angela said.

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

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

"What do you think?" David asked Nikki.

"Would that be where I'd go to school if we come here to live?" Nikki asked.

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

"It's pretty," Nikki said noncommittally.

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

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

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

"You wouldn't have met Mommy," Nikki said. "And then I wouldn't be here."

David laughed. "You're so right and I'm so happy I went to Brown."

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

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

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

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

"I'd say they look reserved," Angela said. "But not unfriendly."

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

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

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

"Me too," Nikki said.

"Well, that settles that," Angela said.

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

"There's no way I'm going to an interview until I brush my teeth," she said.

David took a handful of mints after paying the check.

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

"Oh, how cute!" Nikki exclaimed.

The woman graciously stopped so Nikki could pet the dog.

"How old is she?" Angela asked.

"Twelve weeks," the woman said.

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

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

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

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

"Of course you may have a dog," Angela said.

"You can even pick it out," David said.

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

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

"Like what?" Nikki asked.

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

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

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

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

"What a view," Angela said.

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

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

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

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

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

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

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

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

"Thank you," Angela said.

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

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

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

Angela smiled. "I've tried to do my best."

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

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

"We call it CMV," Caldwell said. "And it's the only HMO in the area."

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

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

"I'm to meet with Mr. Kelley as soon as we're through here," David said.

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

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

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

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

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

"Thank you for making such an effort," Angela said.

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

Angela looked at Nikki. "Why don't you explain to Mr. Caldwell what cystic fibrosis is."

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

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

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

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

"I intend to," Nikki said. "I'm going to study respiratory medicine."

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

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

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

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

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

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

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

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

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

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

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

"I'm pleased you're pleased," David said with an embarrassed shrug.

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

"Sounds like a monopoly," David joked.

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

"Of course," David agreed.

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

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

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

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

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

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

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

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

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

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

"Call me Randy," Dr. Portland said as he shook David's hand.

David sensed the man was sizing him up.

"You play basketball?" Randy asked.

"Occasionally," David said. "Lately I haven't had much time."

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

David smiled.

"Well, it's nice to meet you folks. I'm afraid I have to get back to work."

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

David turned back to the mesmerizing view.

"Well, what do you say?" Kelley questioned.

"I'd say we're pretty impressed," David said. He looked at Angela.

"We'll have to give it all a lot of thought," Angela said.

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

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

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

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

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

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

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

"I thought it was rather remarkable," Angela said.

"Let's not have any hysterical transference," David joked.

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

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

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

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

"I don't know what to say," David admitted when the tour was over.

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

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

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

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

"What about housing?" Angela asked as an afterthought.

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

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

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

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

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

"I can't believe this," David said.

"It's almost too good to be true," Angela agreed.

"Does this mean we're coming to Bartlet?" Nikki asked.

"We'll see," Angela said.

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

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

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

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

"What's capitation?" Nikki asked.

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

Nikki still looked puzzled.

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

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

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

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

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

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

"What's the matter?" David asked. He looked over her shoulder.

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

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

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

"Easy!" David said. "What's been done is done. Let's not get hysterical."

"What do you mean, 'Let's not get hysterical'?" Angela demanded. "Our home's been ruined. The TV's gone."

"We can get another TV," David said calmly.

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

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

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

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

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

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

"Okay, okay," David said agreeably.

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

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

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

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

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

"Don't be ridiculous," Randy said.

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

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

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

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

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

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

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

"There are some things you cannot control," Arlene said.

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

"I thought you were over your depression," Arlene said.

"I'm having trouble sleeping again," Randy admitted.

"Maybe you should call Dr. Fletcher," Arlene suggested.

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

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

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

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

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