THE PROCEDURE
by
Peter Clement


About the Author

Peter Clement, M.D." is a physician who headed an emergency room at a
major metropolitan hospital and now maintains a private practice. He is
also the author of Lethal Practice and Death Rounds. He is married to a
physician and has two sons.

FAWCETT BOOKS NEW YORK

The Ballantine Publishing Group
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Published by The Ballantine Publishing Group Copyright 2001 by
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All rights reserved under International and Pan-American Copyright
Conventions. Published in the United States by The Ballantine
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simultaneously in Canada by Random House of Canada Limited, Toronto.

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Library of Congress Catalog Card Number: 00-193360

ISBN 0-449-00622-0

Manufactured in the United States of America

First Edition: June 2001

10 987654321
ACKNOWLEDGMENTS

My heartfelt thanks to Denise Marcil for her support from start to
finish, to Joe Blades for taking me under his wings at Ballantine, to
my longtime friends Dr. Brian Connolly and Dr. Jennifer Frank for
their encouragement and advice on medical matters, and to my eagle-eyed
proofreaders Betty, Connie, Doug, James, Joan, Johanna, and, last but
definitely not least, Tamara--you are all truly amazing.

This book is dedicated to James, Sean, and Vyta--and all their loving
intrusions while I write--for teaching me every day what really
matters.
THE

PROCEDURE
Prologue

I had to watch the one with the needle.

No matter that I heard the psychiatrist step up to the side of my
stretcher and coolly begin to explain what they were about to do with
me, nor that I felt the tug of the nurse's hands as she secured the IV
in my left arm with adhesive tape. I kept my eye on the silent
anesthetist who was standing behind my head. His syringe lay capped on
a nearby table.

"... thirty seconds after the succinylcholine is injected, you will
feel your muscles twitching, and then the paralysis will occur. The
transmission of neuro electrical impulses through the nerve ends to
striated muscle will be blocked, and all movement, including
respiration, will be stopped. It is the extreme unpleasantness of
mounting air-hunger that will, in the end, condition your response, and
so you will be allowed to endure it for eighty seconds. At that point
the anesthetist will start to ventilate you and will carry on making
you breathe until the drug wears off, in about four minutes. Your
heart will continue to beat, and the drug won't affect your sphincters,
so you won't soil..."

I knew that the psychiatrist's matter-of-fact tone was a lie-others
who'd gone before had warned, "It feels like death." I ignored the
droning words and strained my eyes farther back to keep the anesthetist
in view. All I managed to see now were his hands as he deftly snapped
the blade of a laryngoscope open to make sure the light worked. Then
he glided his gloved fingers over an assortment of rubber tubes and
black curved airways arranged on a tray like an array of hors
d'oeuvres. He adjusted a few of these items so they'd be easier to
reach. Close by, also near enough to him that he could pull them into
position when he needed them, were portable oxygen tanks connected by
green tubing to a black bag and thick rubber mask.

"... you will pour a small amount of your usual drink into a glass.
First, smell it, then take a sip and hold the..."

The nurse moved up beside the anesthetist, bringing with her a small
steel table on wheels. It held a clear bottle the size of a largs
pickle jar and a vacuum pump to provide suction.

She verified the motor was plugged into a wall outlet, then uncoiled a
beige-colored catheter with a metal tip and connected it to a tube
dangling from a stopper which sealed the bottle. The anesthetist
flicked a switch on the table and adjusted the force of suction until
it was adequate to clear vomit from an airway. A nod to the nurse, and
they were ready.

I felt myself start to sweat as I sat up and watched the psychiatrist
reach down into a briefcase and pull out the small green bottle--flat,
contoured to fit in a hip pocket, and with a familiar yellow label.
Some of his subjects, I knew, even at this point, gulped the contents
greedily. Another had told me of being too overwhelmed by fright to
drink anything. If I didn't play this part just right, and anybody saw
through me, I could end up dead.

I saw the anesthetist pick up the syringe. The nurse swabbed a little
rubber side port on the IV line with an alcohol wipe, readying it for
the injection. At least my fear should pass muster, I tried to
reassure myself. It was absolutely genuine and mounting by the
second.

I took the container of whiskey from the psychiatrist when he held it
out to me, but my hands started to tremble and I fumbled with the cap.
Once I got it open, the nurse pressed a glass into my right hand, then
steadied it for me while I poured myself a mouthful of the amber
liquid. The familiar bouquet mingled with the medicinal smell given
off by her fingers. I felt the anesthetist move up to my left arm and
turned in time to see him jab the syringe into the rubber portal. His
thumb was poised on the plunger.

"Now take a sip," the psychiatrist commanded, "then swirl it around in
your mouth."

I needn't have worried about my giving a convincing performance.

My hands began to shake so badly for real that I was afraid I'd slosh
the contents over the side of the glass. The nurse again steadied them
and helped me raise the drink to my lips. As the fluid entered my
mouth I barely sensed the warmth on my tongue. Instead I kept
straining to see the syringe, watching the plunger. My whole body was
trembling now. It feels like death! I tried to swallow but gagged,
and the whiskey dribbled down my chin.

I couldn't continue. I had to stop this. I heard myself start to
moan.

"Swallow it!" the psychiatrist snapped, startling me with the sudden
harshness of his voice.

"Noooooo!" I wailed.

"I changed my mind!" I tried to twist my left arm away from the
anesthetist's grip.

But it was too late. He'd shoved in the plunger before my move could
pull the IV away from the syringe.

I sat frozen staring at my arm. The nurse quickly took the glass and
bottle out of my hands, but I was so transfixed on the IV site that I
barely noticed. The anesthetist moved to the head of the stretcher,
ready for what came next.

I felt a tingling sensation pass through my elbow and rise toward my
shoulder. I started to panic.

"No! No!" I pleaded, looking first at the psychiatrist, then at the
nurse.

"Stop it, please stop it!" But their returning gaze was cold. I tried
to yank the IV out, then clutched frantically at the upper part of my
left arm in a futile attempt to prevent the injection from reaching the
rest of my body. I was sobbing when the twitching started. The
muscles in my arms, my trunk, and finally in my legs gave a few feeble
jerks, then failed me, going completely flaccid. I flopped back on the
stretcher, not breathing, still as death, yet fully conscious.
I caught my reflection in the large circle of stainless steel that
encased the overhead light. My eyes--open, unmoving, the pupils
dilated by terror--appeared unseeing and lifeless.

But I saw all too well, and the expressions on the faces of the three
who'd done this to me were chillingly indifferent as they leaned over
to check my pulse, to document my loss of reflexes, or to simply stare
down at the effects of their work.

Eighty seconds. It had sounded not so terribly long, like nothing much
more than holding my breath. But I had no breath to hold because I
hadn't timed my breathing properly, and when the succinylcholine
blocked my respiratory muscles, what little air I had taken in was lost
as my lungs deflated. The smothering pressure in my chest, unbearable
at the outset, increased steadily. In my mind I bucked and strained
against the grip of the paralysis, but my muscles remained slack,
useless.

I felt entombed, buried alive while locked inside my body.

"Ten seconds," the anesthetist said dryly.

It was beyond enduring. To be suffocating, and yet be so brutally
clearheaded. There was no welcome slip into unconsciousness, not yet.
I couldn't even close my eyes and escape the cruel scrutiny of the
three onlookers. What's more, my senses seemed unmercifully
heightened. I had to listen to the sounds of their breathing as I felt
the pain of no air encase my chest and crush in on me like hardening
cement.

Yet as horrible as it was, the ordeal was what the others had led me to
expect. What came next wasn't. Suddenly I felt burning at the back of
my neck and throat as vomit flowed up my esophagus from my stomach then
poured unopposed down my windpipe. Oh, my God! I thought in alarm.
I'd known without being told that I shouldn't eat or drink before the
session, but during the evening, nervous and unable to sleep, I'd made
myself some toast and tea before midnight.

Normally it should have been digested by dawn, but obviously not by my
stomach, churning as it had been on the levels of adrenaline I'd been
pumping out all night.
"Thirty seconds," the anesthetist said, oblivious to the forming
disaster.

The food particles in my windpipe filled me with the horrific urge to
cough and gag, but the impulse went nowhere, the lifesaving reflex that
might have cleared my airway fully blocked by the effects
ofsuccinylcholine. Instead I lay there, enduring the convulsive
sensation of choking to death while being unable to move.

"Fifty seconds," the anesthetist intoned, methodically opening the
valve on the oxygen cylinders and readying the bag and mask.

My eyes, though unblinking, could still cry. I felt the tears forming,
welling up behind immobile lids and flowing down my cheeks. But my
vision was dimming, the lack of oxygen finally, and mercifully,
clouding my conscious state. Slowly I was freed from the sight of my
tormentors; slowly I lost feeling;

slowly the extreme pain of anoxia in my chest and limbs subsided
somewhat. But the sensation of choking remained intact. It kept
coming in waves. And I could still hear.

"Seventy," a distant voice said.

I sensed I was finished. Even if I survived this, if they discovered I
was an impostor, they'd kill me anyway. The plan I'd made before
coming here had gone so wrong--I'd stumbled into so much more than I'd
prepared for. I felt the anesthetist roughly extend my head and flex
my neck, as though forcing me to sniff a flower. I still could feel
enough to know he'd plopped the mask onto my face, covering my nose and
mouth.

Then, from even farther away, I heard him mutter what I feared would be
my epitaph.

"Shit! The son of a bitch aspirated!"
Chapter 1

Five weeks earlier:

Tuesday, October 12, 7:00 am.

The sight of those tiny human remains spread out before us on the
dissecting tray staggered me despite my knowing what to expect. The
pink unspoiled lungs, a maroon heart, the small ocher-colored liver,
and a spleen the size of a beet--all gleaming under the overhead
light--looked new enough to hold the promise of a lifetime's use. But
the brain, no bigger than my fist, was covered by a thick mesh of
crimson streaks.

These fanned out over its surface and obscured the tightly coiled
ridges and grooves underneath to the point that I couldn't see their
normal beige, gray, and yellow-white coloration.

And the kidneys were so speckled with angry red blotches that a
layperson would have thought someone had spattered them with paint.

From the silence of the other physicians and residents in the room, I'd
deduced that everyone was struggling as much as I was to remain
clinically detached. Not even the voice of the presenting pathologist,
normally our guide to at least make scientific sense out of a death,
could ever begin to explain why this child had died. Instead the words
simply floated over me, like a Muzak of medical terminology, and
consigned themselves to the back of my mind.
"... the inflamed meninges, the characteristic pattern of hemorrhagic
petechiae on the surface of the kidneys, and the rapidity of the
catastrophic process..."

When I examined the brain, holding it in the palm of my hand I could
barely feel its weight through the latex gloves that I'd pulled on in
order to inspect the specimens.

"... the mother noticed symptoms attributable to an upper respiratory
infection the day before. The baby was irritable, off his food,
crying, and had a mild temperature. She gave him an appropriate dose
ofacetaminophen, attempted to keep him hydrated with juice..."

His name had been Robert Delany, and it was a week ago that his life
had ended at eighteen months of age in our emergency department.

"... she telephoned the after-hours number of her health maintenance
organization, as it was late in the evening, but the HMO's triage nurse
told her that the child probably only had a cold and could safely wait
until morning to be seen. Yet the boy continued to cry, his fever
remained elevated at a hundred and three despite the acetaminophen, and
after a few hours the mother once more contacted her clinic. Again she
was told that the baby most likely had the flu and that she should
bring him over only in the morning. When the mother suggested taking
the baby to Emergency that night, she was told she could if she wished,
but since the illness seemed minor, payment wouldn't be pre authorized
at any more than the rate of an office visit...."

The balance of the cost, potentially a thousand dollars if a zealous
resident did a battery of tests, they had told her, would not
necessarily be covered. As a result she delayed several more hours,
until the child had started to seize. The images of what had happened
then, after he arrived in ER, haunted me still.

We'd been like giants gathered around his tiny form while his limbs
jerked with the repetitive rhythm of a grand mal convulsion.

He'd had no respirations, his pressure had been unobtainable, and his
heart rate was slowing into single digits.
"Bag him!"

"His jaw's clamped shut."

"Anybody got a line?"

His eyes had kept flicking to one side, keeping time with the grotesque
dance gripping the rest of him. His skin color, already blue from lack
of oxygen, had quickly darkened to purple.

"... get an IV in his neck..."

"... do a cut-down in his foot..."

"... diazepam up the rectum..."

Everyone had been shouting orders, residents had stuck him with
needles, nurses probed him with catheters, but he continued to seize.
In the end I'd had to grab his pumping right leg, encircle it with my
thumb and forefinger to hold it steady, and drive a needle the size of
a two-inch nail into the front of his tibia to access his circulation
through the marrow within. The steel point had given a lurch as it
penetrated the outer layer of bone with a little crunch, but finally
I'd gotten a route through which I'd been able to infuse enough
medication to make the convulsions stop. But victory had been
short-lived. After he'd been intubated, ventilated, and pinked up a
bit, what caught my attention was a red rash breaking out below his
eyes and spreading over his trunk as I watched.

"Oh, my God!" a resident had muttered, peering over my shoulder.

"Meningococcemia!" What he was seeing was also called
Waterhouse-Friderichsen syndrome, but by whatever name we gave it, we'd
both known immediately what it meant.

Meningococcal bacteria were cascading through the bloodstream from
infected meninges at the surface of the brain and arriving at the skin.
Once there, these microbes produced toxins that attacked the lining of
the blood vessels, and it was the subsequent hemorrhagic leaks that led
to the red spots. The same process was going on in the vasculature of
every vital organ in the boy's body, especially in the kidneys. He
could be dead within the hour.
I'd turned him on his side, curled his tiny form into a ball, and held
him as a resident pushed yet another two-inch long needle into him,
this one between the spines of his third and fourth lumbar vertebrae.
Through my hands, which I'd placed on his little back to keep him from
moving, I felt the give of the needle tip when it punctured the
membrane containing the spinal cord and its surrounding fluid. As the
young doctor drew minute samples of this clear liquid into several
tubes for testing, it flashed through me how the feel of the child
against my arms was so much like that of Brendan, my own infant son. By
the time we'd finished the procedure, one of the surgical residents had
dissected open a vein in his foot and another had inserted an IV line
into his jugular at the neck. We'd then infused a loading dose
ofceftriaxone, the indicated antibiotic.

With nothing left to be done, I'd stood away from the stretcher and
viewed our work. The sight of that poor struggling infant, stuck with
tubes, needles, and catheters, had brought me to tears.

Later, once all our efforts had come to nothing and I'd pronounced him
dead, I cut each one of these lines off at the skin.

My leaving their tips inserted had been in order to verify their
position later at autopsy, but I hadn't wanted them protruding from the
boy's body, in case the mother asked to see him. I'd then cleaned away
the blood, covered the puncture sites with small Band-Aids, and placed
a blanket over him. I'd had to concentrate especially hard doing that
last simple act. Thoughts of tucking Brendan in kept rushing to mind,
and once more I nearly lost the fragile hold I'd had on my own
emotions. I'd then gone to tell the mother that her child had died.

Even now, a week after the boy's death, I could still visualize the
horrible expression I'd seen on her face during the instant she looked
up when I entered the room where she was waiting. In that second of
exchange, before I'd spoken a word, the light flowed out of her eyes
and her face collapsed from a rigid mask of hope into a fluid swirl of
agony and grief.
Later, as I'd supported her, she stood over the already whitening
corpse of her child.

"Can I hold him?" she asked.

The nurses looked appalled. I'd swallowed my own alarm, lifted the
tiny bundle off the stretcher, and handed it to her.

"... Dr. Garnet, is there anything you wish to add to the presentation
of this case, before pronouncing whether the death was expected or
unexpected, avoidable or unavoidable?"

The pathologist's question pulled my thoughts back to the present.

It took a few seconds longer before I could collect myself enough to
speak. There were specific lessons I wanted the residents to take from
this, but I wasn't sure how much of what I was thinking I should
reveal.

"I think we have to talk about what happened prior to the infant's
admission to Emergency," I began.

"In particular, if the mother hadn't been put off by her HMO, her
instincts about the child being sick enough to warrant a visit toER
might have gotten him here sufficiently early that we could have saved
him."

"What did the HMO representatives say when they learned of the child's
death?" asked a young woman across the table from me. She was
planning a career in ER and was doing a rotation in my department.

"I presume you told them."

"Oh, I told them all right, but they'd covered themselves legally.
Notice what their triage nurse said to the child's mother. She could
take him in toER if she thought he was seriously ill, but if the visit
wasn't justified, they probably wouldn't cover the cost of any tests.
It's a variant of what HMOs always claim--"We don't withhold care; we
withhold payment'-and by so doing they make the choice of whether to
come in toER rest with the patient, or as was the case here, with the
parent. According to this usual spiel of theirs, the delay was then
her doing. Reminding her of company policy regarding trivial visits,
and their refusing to pre authorize payment of costly tests, was simply
standard procedure, not a violation of any law. The fact that she
second-guessed her initial impulse to get the child help after hearing
the reminder made it her responsibility, not theirs. And legally,
they're right. Of course they are very sorry the baby died, and his
visit will be covered, they were quick to tell me, since he was
obviously quite ill."

Only the first-year rookies let out exclamations of disgust and
surprise. Everyone else in the room was well used to how the deadly
game for profit was played.

"But that's wrong," one of the newcomers said.

"They gave her medical advice not to come in. They have to be legally
accountable."

"A lot of lawmakers agree with you, but not the law as it stands," I
replied, watching the incredulity grow in his eyes.

"In 1998 the so-called patients' rights bill that would have redressed
that very issue was defeated. And watch out, all of you, while you're
in ER, that you don't get caught by another dodge that these companies
use, or you yourself will be left paying for the consequences of their
decisions to withhold payment."

The resident looked alarmed.

"How could that be?"

"If they refuse to cover an admission or a treatment of someone in ER,
and you go along with that decision, despite your better judgment, you
are liable for damages, even though they aren't."

"But that's crazy," another innocent exclaimed.

"That's reality" I snapped, "and in particular watch out for the HMO
this poor woman belonged to. They're a new outfit in town called Brama
Health Care, but they've been operating on the West Coast for decades
and know every trick in the book about how to discourage people from
going to the hospital yet still remain within the law. In fact,
they're the ones who first pleaded the "We withhold payment, not care'
defense, thereby rendering it the industry's battle cry whenever a case
goes wrong. Now they're bringing all that expertise to the East, and
according to the junk mail they keep bombarding us with, they intend to
be the first HMO to have a presence in all fifty states plus the
District of Columbia. So wherever you plan to practice, you'll be
crossing swords with them, and since the lawyers for Brama are the best
in the business, I think every resident here with a desire to make ERa
career should listen to them argue a case in court, because then you'll
know what you're up against. Remember, their standard line means that
it's up to you or me as doctors to know what to do medically,
regardless of what any triage officer says they will or will not pay
for.

"Those statements are simply policy guidelines, not medical decisions,"
I've heard them claim, and the judges agree with them."

In previous years my sole duties as a teacher were to arm the residents
against the wily ways of a disease like meningococcemia.

These days the curriculum included instruction against the perils of
managed care.

"You mean what Brama Health Care did to this baby will go unpunished?"
someone else asked.

He was answered with silence.

The pathologist cleared his throat and tried to wrap up the meeting.

"Dr. Garnet, would you care to give us your pronouncement on the
case?"

Death Rounds always ended with a judgment on whether we could have
prevented the patient in question from dying. It was the ultimate
point of the exercise--to identify what we did right, and to temper our
skills by learning from our failures.

I hesitated before answering, glancing over the young faces of the
residents turned toward me.

"Dr. Garnet?"

I looked back at the organs on the table.

"Okay, here's what I think. If we look at the case simply from the
time the child arrived in ER, the death, tragically, was expected and
unavoidable."

Immediately there was a murmur of agreement, followed by a rustle of
movement and a scraping of chairs as everyone began preparing to
leave.

"However," I added, raising my voice above the noise, "we can't in all
conscience ignore what happened in the prehospital phase of this
child's illness." I waited a few seconds until the room grew quiet
again, then continued.
"Had the mother not been intimidated by Brama Health Care and brought
her son in earlier, the death might have been prevented."

"So that's your ruling? You're calling this a preventable death?" the
pathologist asked, his forehead creasing.

"That's really not the domain of these rounds, to comment on
prehospital events--" "Then let's make it our domain," I shot back,
staring at the remains of little Robert Delany. I felt a surge of fury
against the likes of Brama and the new world of medicine that they and
their kind had created. A world where a decision to withhold care to
maximize profit could cause injury and death, and yet by law no one was
accountable.

"In fact, I know exactly what we should label this death, and every
death like it.

No-fault murder!"
Chapter 2

Treating Dr. David Pearson for yet another drinking hinge was about
the last thing I was in the mood for when I got back toER from. Death
Rounds.

"Don't turn your back on him," warned Susanne Roberts, our head
nurse.

"According to his wife, he's making threats against you again."

"Christ! Is he as far gone as usual?"

"Shaking like a leaf, seeing spiders all over the walls, and primed to
seize. I put a resuscitation cart by his bed."

"Have his bloods been drawn?" I asked, flipping through the resident's
admission note.

Susanne gave me her what-do-you-think stare and rushed off to meet two
ambulance cases that had been wheeled into triage one after the
other.

I started toward the room where they'd put David and tried to prepare
my mind for the ordeal I knew awaited me there.

But on my way I passed a row of patients who were all in some form of
extremis. One man had just vomited frank blood into an already
overflowing kidney basin. The alarm in his eyes grew as he watched the
stain on his bedclothes keep spreading and spreading. Two residents,
one at each arm, were starting IVs while a nurse was quickly snapping
electrodes to his chest and connecting him to a monitor.

"You okay here?" I asked.

"Yeah, Surgery's on the way," answered the more senior of the two young
physicians.
In the next bed a man was leaning forward and gasping for breath.

"Doctor! Help! Can't breathe."

A nurse pushed by me and applied a clear plastic oxygen mask to his
face, then attached a cylinder of albuterol to its tubing. She twisted
open the wall oxygen outlet, a hissing sound filled the air, and within
seconds a plume of vapor surrounded the patient's head. She glanced to
where I was still hovering at the foot of the bed.

"Everything's under control, Dr. Garnet. ICLTs already waiting for
him."

I tried to tune out all the other sights and sounds that beckoned to me
from all corners of the emergency department and walked the rest of the
way to David's room, resenting him for pulling me away from where I was
obviously needed, despite the reassurances to the contrary. When ER
was busy like this, even if the residents, nurses, and other staff had
the individual cases covered, it was important I be around--visible at
the helm and available to help out.

No sooner was I through the door than the sour aroma of exhaled
alcohol, sweat, and stale vomit cut into my nostrils, pushing its way
to the back of my throat, making it hard not to gag. David was splayed
out on the bed, his wrists and ankles bound to the side rails with
leather cuffs. Orange and green stains covered his hospital gown. Pale
yellow fluid--a mixture of vitamins, glucose, and normal saline--ran
into his arm through an IV His vital signs beeped and flashed on an
overhead monitor.

At first I thought he was unconscious, but his head jerked up as soon
as I got near him. He stared at me, his black pupils glinting from the
bottom of his puffy eye sockets. His face was crimson beneath what was
left of his dyed black hair.

"You!" he screamed.

"You dare look at me, you fuck? You're the reason I'm like this!"

"David, stop it!" I ordered, and quickly closed the door behind me so
he wouldn't disturb the other patients.

"You know why you're here."
"Because you fired me, you bastard! Fired me--" His roaring abruptly
broke off and his eyes fixed on the wall behind me. The red color in
his enraged face paled and his pupils grew even wider. His mouth moved
noiselessly then he issued a low moan. He started to yank and strain
against his straps.

"David, what are you seeing?" I asked, changing to as gentle a tone of
voice as I could muster.

His groaning sounds made a crescendo into a scream.

"David, they're not real," I told him firmly while reaching for the
medication tray Susanne had laid out. On it I found syringes and a
selection of vials filled with injectable
benzodiazepines--chlordiazepoxide for agitation; diazepam, or Valium in
case he seized.

"It's spiders!" he sobbed, his expression growing more terrified by
the second. His eyes seemed to be tracking something coming toward him
across the ceiling.

I grabbed the order sheet and quickly determined how much
chlordiazepoxide the resident had given him. My calculation told me he
could take more.

"Oh, God! They're going to drop on me. They're going to drop! Help!
Help me!" His screams became a shriek, and he began thrashing his head
from side to side.

"They're covering me. I feel their legs. They're swarming all over.
Oh, God, no!" He broke into a wailing sob, writhing in his
restraints.

Then he let out a bellow, his body arched backward, and his muscles
locked in the quivering rigidity that marks the start of a seizure.

"Nurse!" I screamed, throwing open the door. By the time she arrived
I'd grabbed a vial of Valium injected the works into his IV, and
managed to slide a naso pharyngeal airway down his nose to shove his
tongue off the opening to his trachea.

The seizure broke, he began to breathe, and I arranged to transfer him
to I.C.U.

"He was once a doctor?" the resident who received him upstairs
commented. The young man's face had registered disgust the instant he
spotted David's bloated body covered with the spindly network of
broken veins that are peculiar to alcoholism. His smug choice of tone
further set me to gritting my teeth. Despite my own frustration with
David, I'd be damned if I was going to let some kid barely out of his
teens sit in judgment of him.

"Yes, he was once a doctor," I said tersely, "and a good one. I only
hope you're near as skilled as he was while you care for him now."

The resident's face flushed.

"I'm... I'm... I'm sorry. Dr.

Garnet. I didn't mean any disrespect--" "Good. Now here's something
else you should know. Help me turn him on his side." The startled
resident moved smartly to assist me as I rolled David toward us until I
could undo the ties on the gown to expose his back.

"My God!" my helper gasped.

We were looking at scars the width of a one-inch rope coiling up and
down the length of his spinal column. Pointing to the gnarled red and
white tissue, I explained, "On his chest X ray you'll see a half-dozen
metal fragments embedded near the thoracic vertebrae. He got them in
Vietnam, before you were even born." I turned and walked away, not
wanting to explain any more of David's tragedy, but reasonably certain
that I'd put an end to the resident making any more snide remarks.

I took the stairs leading down toER and paused at one of the landings
to cool down. David inevitably robbed me of my objectivity whenever he
came in. The reason was pathetically simple. As much as I told myself
over and over that I'd done the right thing with him all those years
ago, I was never entirely sure that I couldn't have handled him better.
It didn't help any that each time he turned up in ERat the end of a
hinge, he seemed to have a cunning ability to resurrect every one of
those doubts.

"Damn you, David," I muttered, and continued to descend the stairs.

Some judgment calls we are sentenced to second-guess for the rest of
our lives. My decision to fire David when I'd first taken over as
chief of the department ten years ago was one of those burdens.

Up until that time he'd been doing the ER shifts nobody else
wanted--nights, weekends, holidays--in hospitals all over Buffalo, ours
included. But useful as he was in his role as a permanent fill-in, it
was also evident even then that he drank too much. As far as I knew,
the man had never come to work drunk, but everyone in the department
could routinely smell stale alcohol on his breath from the drinking
he'd done when he was off duty. In addition, the telltale skin
markings that I'd pointed out to the resident had already started to
appear, and sometimes his hands shook, albeit ever so slightly, when he
was doing an invasive procedure. Taken together, it was easily enough
to make him the butt of departmental jokes.

"Is the red-nosed reindeer on tonight?"

"Need to swab a needle site with alcohol? Just have Pearson breathe on
it."

"There'll be a whole lot of shaking goin' on."

My predecessor as chief, rather than risk losing an easy way to fill
gaps in the schedule, had turned a blind eye to the problem. By the
time I took over, it was rumored that David regularly "topped himself
up" mid shift claiming he was going to the bathroom, but returning
red-faced and smelling of mouthwash.

"Get help" I'd told him when we met in the privacy of my office and I
confronted him.

"I'll set it up for you. It's been a miracle nothing's happened with a
patient up to now. For God's sake, David, straighten out, and then
we'll see."

"You're firing me?" he'd demanded.

"I can't let you work like this. You know I can't."

He'd suddenly stepped forward, bringing himself to within a foot of me,
and yelled, "You're a fucking asshole. Garnet!

I've made myself available to this ER for years, and this is how you
pay me back?"

I'd been terrified by the rage I saw in his eyes, and his
powerful-looking arms and shoulders always appeared formidable. He'd
then brought his hands up between us, and I watched his fingers curl
and uncurl inches from my neck as he threatened, "You'll be sorry! You
hear me? Goddamned sorry!"

But instead of attacking me, he stormed out of the room.

Soon afterward, I heard all the other hospitals had stopped using him
as well. Subsequently, his drinking had gotten worse, and it wasn't
long before he required his first admission toER--mine--to be dried
out. Each admission after that, he was in progressively worse shape,
and every time he'd arrive blaming me for pushing him into the spiral
that his life was hurtling down.

But out of the blue a small miracle had happened. In one of his sober
periods, he started to write medical articles for a local paper. In
them he'd shown a skill for explaining illnesses and their treatment in
terms that laypeople could understand. There was a good public
response, people began sending him questions about health matters, and
soon he was doing a regular feature. In no time he was invited onto
talk shows, answering questions about medical problems the listeners
phoned in. So popular had the format been that the radio station
offered him a regular half-hour slot. Almost overnight the man had a
new career.

I'd occasionally catch his program and sometimes glance at his column.
He had a nice blend of being easy to read or to listen to while
remaining clinically accurate. But one night while driving home I
heard him describe his own struggles with alcoholism, and on that
occasion he'd verged on being great.

"I drink to escape the wrongs in my life--those of my own doing; those
which were done to me; those which I witnessed being done to others.
Not that these events were any worse than what's befallen the next
person--others have endured greater calamity and not taken to
drink--but I suspect my tolerance to the pain is less. What's harder
to grasp is why I also drink when life goes well, yet that's often when
I'm most afraid--those times when hope is as great an agony as
despair;

when success makes my fear of failure unendurable, or when love leaves
me terrified of insurmountable loss. Then I end up drinking to
obliterate the waiting for it all to go bad.

Whatever the occasion that starts me off, however, the finish remains
the same--drinking to obliterate the drinking itself, holding off the
shakes, heaves, DTs, and, worst of all, the deep loathing which
congeals like ice in the soul each time withdrawal threatens."

It was as good a description of what drives addiction as I'd ever known
to have come out of a medical text.

During this period, his own frequent admissions toER had stopped, and I
held my breath, for a while.

Within a year the inevitable had happened. Intermittently his articles
would not appear and his radio spots would be preempted, replaced
without explanation with previously recorded broadcasts of his show.
Sooner or later he'd show up in ER, once more raging at me while seeing
bugs that weren't there, and we'd start again. For me, it added up to
ten years of watching the man squander more chances than anyone had a
right to expect in a lifetime. For him, it had been a slow stroll
toward his own destruction, a stroll that not he nor anybody else
seemed able to stop, a life rapidly running out of possibilities.

Back in ER, I rushed over to triage and took charge of the latest
patient brought in by ambulance. Yet as I grabbed her chart and
listened to her complain about being short of breath, David's bleak
prospects continued to weigh heavily on my thoughts.

"Damn you again," I muttered, and by sheer willpower forced him enough
out of my mind that I could do my job.

By six a.m. our bed was usually a pretty crowded place.

My wife. Dr. Janet Graceton, while as slender as a dancer, was tall
and liked a lot of room. Muffy, our pet poodle, had a penchant for
crawling between us in the early morning hours,
placing her paws against my back and pushing until she made herself a
big enough spot to stretch out in. She'd usurped this "right" ever
since she was a puppy five years ago, except now she weighed fifty
pounds and had enough strength in her legs to shove me half off the
bed. Finally came the newest interloper, Brendan, our
two-and-a-half-year-old son. Since he'd been able to climb out of his
crib, he quickly learned what he had to do if he wanted a cuddle from
his parents before they left for work. And so the predawn gathering
had become a routine, one that served as an oasis from which Janet and
I could greedily drink up a store of love and sanity before embarking
on our increasingly long and brutal days at the hospital.

That morning it felt especially cozy to linger in bed, as outside a
gray mist was pasting itself against the windows and periodic gusts of
rain peppered the glass panes like handfuls of sand.

Janet and I had been talking about the previous day while I lay on my
back and held Brendan up in the air, swaying him from side to side
while he, squealing with laughter, pretended to be a plane.

"No-fault murder?" Janet was saying.

"That's quite a shot, Earl. The residents must have loved it, but I
wouldn't advise repeating the charge outside of Death Rounds, in case
some lawyers over at Brama start taking exception to it."

Brendan shrieked happily in agreement.

"I don't know. Going public with a case like Robert Delany's might
smarten up the members of their board. The way I read how people are
feeling about HMOs these days, it wouldn't take much to ignite the kind
of pressure even Brama couldn't ignore. And in some towns it's been
the doctors who have brought local offices to heel."

Janet snorted. She was lying on her side, her head cupped in her hand,
watching Brendan and me.

"Don't count on it here," she said, stretching up with her free arm and
tickling his side.
"Don't Mommy!" he screeched, then promptly demanded, "Do it some
more!"

"Haven't your patients had enough?" I continued, waving Brendan
through the air.

"Christ, the other day I couldn't get pre authorization to admit a
pregnant woman who was already in labor."

Janet giggled.

"I heard about that one from the residents.

Did you really threaten to deliver her on TV and invite expectant
mothers to pay Brama a visit?"

"Of course not. I simply suggested that if that was their new
obstetrical policy, I'd be glad to announce it to the media for
them."

Janet flashed me a wicked grin.

"You dog."

Brendan gave another shriek and invited more tickling. I swooped him
into his mother's arms, where he squirmed around as Janet and I quickly
obliged. His gales of laughter were now enough to make Muffy insert
her snout under one of my hands and toss it in the air, her way of
signaling that she too wanted some attention. I was scratching her
ears and tickling Brendan behind his neck when Janet leaned forward and
let her hair shower around his face like a gold curtain.

"Do you know Daddy's best tickle spot?" she whispered, not too softly.
Soon they were both attacking the soles of my feet, I was begging for
mercy, and Muffy was barking excitedly.

In all the noise, I barely heard the phone ring. But Janet did.

Like all obstetricians, she was so sensitized to being called that even
in a deep sleep she would manage to pick up the receiver before it rang
twice, "Dr. Graceton here."

I got both Brendan and Mufiy quieted down.

"How many centimeters?" she asked coolly, all trace of her laughter
vanished. She listened to the answer, then replied, "I'm on my way."

As she quickly dressed and gave me a string of instructions about
Brendan, I marveled at the youthful forty-year-old woman who was such a
force in my life. I couldn't count the times I'd watched her rise from
our bed, pull on her clothes in the darkness, and rush off to a
delivery. Since we first became lovers twelve years ago, then man and
wife a year later, and now parents, her beauty and energy seemed
undiminished. I couldn't imagine a job more fitting for her than
bringing life into this world.

In an instant she was out the door, leaving the three of us to somehow
muddle through breakfast without her.

A few days later I got a message from the nurses on the floor that
David Pearson wanted to see me--to apologize. I kept putting off
going, but by early evening when I finished in ER, I'd resigned myself
to facing him yet again. If I didn't, I figured, I'd be even more
haunted by the man than I was now.

He was standing by the window of his room looking out at the stumpy
skyline of downtown Buffalo, watching it glow in the final minutes of
the setting sun. But the golden light did nothing for him. His color
was pale, his appearance wan, and his hand trembled as he reached to
shake mine. Yet he greeted me with a steady gaze, and his eyes had the
beginning of a spark in them, enough to suggest that he was coming back
to life.

"I'm sorry, Earl. I can't say how sorry I am for what I did" "It's
nothing, David," I insisted with as much enthusiasm as I could
muster.

"Just get well. Are you going home soon?"

I didn't dare ask about work. For all I knew, they'd already sacked
him.

He grimaced.

"No, I can't simply dry out and go back to my old routine this time.
It's my last chance. The paper and the radio station both say if I
screw up once more, I'm gone."

He looked frightened, as he always did after a hinge when he assured me
of his determination to stay dry. The reality was that he had less
than a forty percent chance of breaking off from his addiction, and
each time he fell out of remission, the odds against him grew, while
the risk of death drew closer.
I found myself looking away, hoping he wouldn't read in my expression
how little hope I had for him.

"At least you've still got a chance, David. That's something," I said
lamely.

He grabbed my arm.

"I've got more than that. Earl. They've offered me a new addiction
treatment. It's experimental, but they say the results are good."

The declaration took me by surprise.

"What treatment? I haven't heard of any new program--" "It's not
here," he continued in a rush. His eyes had all at once become too
bright.

"It's in Mexico!"

"Mexico!" For an instant I thought he must be confabulating, having
some sort of delayed alcohol-induced psychosis.

"Look, David, maybe you'd better lie down--" "No, Earl, it's true. I'm
being sent to an addiction research center that's run by my HMO--in
Mexico, somewhere near Tijuana. Apparently it's cheaper to fly me
there than to keep me here and pay the daily room rate at St. Paul's.
Believe me, I'm grateful, and my family's ecstatic. Obviously they're
pretty fed up with me too."

"Still, it sounds pretty exotic, Mexico and all. I find it strange
that any HMO would bother--" "It's simple, Earl. If this program works
like they say and I stay out of trouble, it'll save the company a
bundle by avoiding an endless string of readmissions. Besides, I've
got to quit. If they can just get good results with me..."

His speech became increasingly rapid, the blacks of his eyes widened,
and he exuded a desperation that I found chilling. Whatever treatment
he was going on about, he looked and sounded like a man who didn't
think he'd succeed with it any more than I did. Then he added, "The
Brama program's my last chance."

At first I thought I couldn't have understood him properly.

"Brama? Brama's offering you a program? You're sure?"

He nodded.

"Yep."

"But they hardly even cover basic care. Why would they be offering you
a special program?"
"Like I said, they were very clear that it was a matter of keeping
both current and future costs down. They also made no bones about the
fact that even if I didn't want to go, I had no choice but to accept.
Their agent read it to me from the fine print of my policy.

"Noncompliance with any prescribed treatment which leads to further
medical expenses is grounds to de insure the patient." So as far as
Brama's concerned, I'm in, like it or not, or I'm out altogether,
because either way it'll help their profit margin."

"But what's the treatment?"

"Probably it's one of the new anti craving drugs, but I won't know
until I get there. I'm part of a study. Besides, I couldn't even tell
you if I did know. I had to sign a confidentiality agreement which
forbids me to talk about the method until they publish their
results."

Largely because of David, I'd kept my reading on the longterm treatment
of alcoholism up-to-date. Anticraving drugs were the latest hope to
crack problem drinking. The first on the market, naltrexone, hadn't
helped him.

"How long will you be there?" I asked, still making an effort to sound
hopeful.

"Again, no idea, though I gather it'll be at least a month.

No other detox joint I've ever been in has kept me less than thirty
days."

"Jesus, David, it sounds pretty strange. Are you sure--" He grabbed me
by the shoulders and looked at me with eyes that were as black as an
abyss.

"Earl, I told you, I'm beyond any more tries. One way or another, I
won't be back in your ER stinking up the place and screaming about
spiders. I have to make this attempt work--have to--or I won't have
anything left--not my family, not my job, and before long, probably not
my life!"

There wasn't much to say after that. We made a few minutes' worth of
small talk, I managed to find some more hollow sounding words of
encouragement, then we shook hands. Before stepping into the elevator
I glanced back to where I'd left him standing at the door to his room,
and winced. He appeared so pale and lost in the folds of his robe
that he resembled a corpse draped in a red shroud.

I rode down to the ground floor trying to digest the absurdity ofBrama
offering treatment to David while having withheld it from little Robert
Delany.
Chapter 1

Exactly as Janet had foreseen, it hadn't been such a good idea to
accuse Brama of practicing no-fault murder. Official minutes of the
Death Rounds proceedings had quoted my comment, and although this
document is normally considered so sensitive that it's limited to a few
copies held in the hospital vault, somehow someone had leaked a
photostat to the local Brama office. A few days later the media picked
up the story. My accusation appeared on the front page of Buffalo's
sole daily newspaper, filled the talk shows, and was the lead story for
local TV newscasts. Although I refused to speak to the flurry of
reporters that dogged me for followup quotes, the public debate over
nonaccountability in HMOs had raged for days during hastily organized
radio phone-in specials dedicated to that topic alone.

I'd since had about three weeks' worth of hindsight to show me the
error of my ways for having caused such a stir, and most of that
hindsight had been provided by some of the men and women in the room I
just entered. They were the hospital leadership--chiefs, directors,
administrators--gathered for a reception being held to honor a
departing anesthetist. But for the moment they seemed more intent in
displaying their displeasure with me. A few stopped talking as I
walked by.

Others whispered together while glancing in my direction, then glumly
shook their heads and turned their backs on me. The most direct barb
came when I drew near a group of internists. Their chief, Arnold
Pinter, a mousy little man dressed in an oversized lab coat, was
complaining loudly.

"They're sending all their patients to at least a dozen other
hospitals, ever since that ER loose-lips mouthed off about their triage
policy. I don't know about you, but my income's down ten percent." The
rest murmured in agreement and a few slid their eyes toward me as I
passed.

Shunning, St. Paul's style. At least they hadn't clucked their
tongues and wagged their fingers at me.

I tried to ignore the silly display and looked around for the guest of
honor. Dr. Hector Saswald, Chief of Anesthesia. He'd abruptly
announced last week that he was leaving to work in a chain of
freestanding day surgeries, run by Brama no less.

I wasn't exactly surprised, or sorry to see him go. He'd spent a lot
of weekends freelancing at these same facilities over the last year,
and frankly, I felt his department functioned better without him
around. He always seemed too taken by the business and politics of
medicine for my liking, and I had no problem wishing him on Brama.
Nevertheless, he was a fellow chief, had survived for longer than I'd
served so far in the role, and occasionally had been on the same side
of an issue as I was. Whatever I thought of him personally, I felt
duty-bound to take the high road and wish him well.

Yet I had no idea how he would respond, given the trouble I'd stirred
up with his new bosses, and I was relieved when I saw him talking with
one of the few friends I still had among the ruling elites of St.
Paul's. Where the anesthetist was short, balding, and terminally
sullen, the man beside him, surgeon and chief Dr. Sean Carrington, was
over six feet in height, had a mop of frizzy red hair, and a laugh that
carried the width of any room. I quickly strode over to where the two
of them were standing and heard the tail end of Sean telling a zany OR
story that had coaxed a smile out of the usually humorless Saswald.

"... after his friends put Krazy Glue on the toilet seat, they had to
unbolt it so he could wear it to the hospital. The residents in ER sat
him in acetone for an hour, but in the end I had to cut the thing away
from the skin-Hey, Earl," he broke off, giving me a welcome grin when
he saw me approaching.

"I

was just reminiscing about the toilet seat man. Weren't you on that
night?"

The thought of it made me chuckle.

"I was not only there the night he came in, but also the following
morning when those so-called friends of his had the nerve to turn up
demanding we give the seat back."

Sean's grin widened.

"Remember what happened in triage?"

Now he had me laughing outright.

"You mean when he waddled up to the receptionist with a toilet seat
visibly stuck to his ass, and she still told him to 'take a seat'?"

Sean had said the punch line with me, like a duet, setting us to
laughing even more. Yet I knew there was more than his love of fun
behind our fooling around. There was no doctor more influential in St.
Paul's. Over the last few weeks, as patient numbers fell along with
doctors' incomes, and animosity toward me had grown, he'd made a show
of our friendship whenever he could. Everyone went on blaming me for
invoking Brama's wrath, but Sean's support seemed to put a ceiling on
how far their hostility could go. Whenever I tried to thank him for
being such a good friend, he pretended not to know what I was talking
about, insisted that the only reason he kept on speaking to me was
because no one else would laugh at his jokes, and proceeded to tell me
yet another of his funny tales.

But when I turned to Saswald intending to wish him luck, I saw by the
scowl on his face that he didn't care whose friend I was. I held out
my hand anyway and said simply, "All the best. Hector," figuring I
would get my well-wishes over with and slip out immediately, before my
presence became any more of an embarrassment.

He shook it without any enthusiasm, and in a cool voice stiffly
expressed his admiration for Janet as a wonderful surgeon.

"Please say goodbye to her for me," he added, apparently prepared to
act in a minimally civil manner despite his disapproval of me.
I just as stiffly assured him, "Why, I'd be pleased to pass on your
compliment to her. Hector. I'm sure Janet will be delighted."

Then, encouraged by the fact that we were at least talking, I decided
it might be as good a time as any to ask him about something I'd
figured only he would be able to help me with.

"Hector, in your travels for Brama, did you by any chance ever run
across an addiction research unit they run in Mexico?"

He pulled his hand out of mine, ending our shake and his civility.

"Of course not," he replied, sounding annoyed.

"Why would you think they'd need an anesthetist in an addiction
center?" He then gave my hand, still suspended between us, such a look
of disgust that I thought for an instant he might spit on it. I
needn't have worried. He looked up and spat at me with words
instead.

"How can you laugh and joke, after what you've involved this hospital
in? And I certainly don't see why I should tell you anything at all
about Brama."

His harsh tone made people standing nearby fall silent. I felt my face
burn as it grew flushed.

"Look, I'm sorry. I didn't intend those comments to go public. I
certainly never wanted to cause damage to St. Paul's. If I could fix
this--" "You could resign!" Saswald blurted.

"Make a public retraction, and resign."

The burning spread down my neck, through my chest, and into my gut.

"Your new bosses tell you to say that?" I asked, letting my anger
sound.

He started, and I got to watch his face turn red. He took a step
toward me.

"You smart-assed cocksucker, I resent you, I resent what you did, and I
resent what you said. How dare you insult me or libel where I work--"
"Easy, Hector," Sean warned. He'd swiftly moved up to lay a
restraining hand on the man's shoulder.

Saswald shook it off.

"Butt out, Carrington. Garnet can't slander a company like Brama and
get away with it. Hell, it's one thing to get himself in hot water for
spreading lies, but he's jeopardizing the hospital's relationship with
an important provider of patients, and that's an unforgivable--"
"I think Dr. Garnet's absolutely right about Brama," said a voice
from behind me. I turned to see our new CEO, Reginald Fosse, regarding
Saswald and me with a bemused smile. He was a balding man in his
mid-sixties with a few strands of white hair pulled across his bare
pate. Though his portly tummy, mil beard, and wire-rimmed glasses gave
him a grandfatherly air, his flinty gaze could wither a man half his
age.

"In fact," he continued, "I think Dr. Garnet deserves our support for
standing up to Brama for what they did to that poor little boy."
Despite his being a head shorter than I, he stepped up and put his arm
around my shoulder.

"Now, Saswald, you have a lot of people to say goodbye to, so I suggest
you get started. Earl, I'd like to see you over here for a moment."

Saswald's jaw dropped and he stood transfixed while Fosse led me away
toward a quiet corner of the room. Sean gave me a wink as we passed,
then turned to join a group of his own departmental members who were
gulping down a plate of pineapple pieces the way surgeons always
eat--as if they'd be called to the OR any second. The other onlookers
went back to sipping a variety of colored juices and munching cheese
cubes off toothpicks.

Fosse didn't say anything until we were well out of earshot.

I'd only known him for little over a year. He'd been CEO at Janet's
former hospital, and when our two institutions were forced to merge at
the St. Paul's site early last winter he was named overall CEO. His
degrees were in business, not medicine, but he seemed a good
administrator, had a reputation of being absolutely ruthless with
anyone who stood in the way of his running a well-managed hospital, and
was extraordinary at raising endowments. But that he'd go as far as
standing up for me and speaking out against Brama was a complete, yet
comforting surprise.

"It's been rough on you these last few weeks, hasn't it?" he stated in
a hushed voice.
I grinned at him.

"Any other events on the calendar you'd like me to torpedo with my
presence?"

He gave me a gracious smile.

"I spoke out because I wanted you and the rest of the hospital to know
that I support you, that I meant it when I said you're absolutely right
about Brama and others like them. You've no idea how much it sickens
me what they're doing to health care. But I also have to warn you that
you've obviously struck a nerve with them.

They wouldn't be coming after you and this hospital the way they are if
you hadn't."

"Would it help if I issued a retraction? I never in my wildest dreams
thought they'd punish a whole hospital--" "They don't want a
retraction, they want you fired. A lot of the board members have
already been quietly approached and told that that's what it would take
for Brama to lift their boycott of St. Paul's."

"What?"

"I know, it seems completely over the top, but managed care is
terrified a case like Robert Delany's could be a rallying point for a
public outcry that they couldn't contain. They've never forgotten how
they nearly got their wings clipped by the patients' rights bill which
almost passed in 'ninety-eight, and they know full well they only
escaped that legislation because the country at the time was more
focused on the President's zipper than on health care."

"Still, their response seems a bit excessive. It's not like I
deliberately set out to accuse them in the media."

"As far as they're concerned, you might as well have. Earl.

And never forget it's a trillion-dollar-a-year industry. Nothing's
excessive when that kind of money sets out to protect its interest. I
repeat, I'll hold off the board members for as long as I can, but be
very careful, and be ready for a full-fledged attack on your continuing
as Chief of Emergency at next week's meeting."

I groaned. The second Wednesday of every month was the fixed date when
the directors of St. Paul's regularly got together, and I was the
lone physicians' representative. I'd been appointed to the position
last year, when I'd been a lot more popular with both doctors and
management than I was now.

"You must show up," Fosse warned, his eyes flashing darkly.

"Our best chance to get you out of this mess is to confront them
head-on, and I'm willing to do that with you."

Shaken as I was from hearing the extent of the backlash that I'd
unleashed, I took heart from the zeal of his support and thanked him,
then headed for the door. After causing such a stir when I arrived, I
don't think my leaving attracted anybody's notice. The surgeons,
having cleaned out the pineapple tray, had moved on to a table laden
with wedges of brown-looking pears. Saswald was working the more
genteel parts of the crowd, where the internists circled around each
other while continuing to nibble their tidbits. I could tell by the
expression on his face that he was still furious, and when he greeted
Arnold Pinter with a hearty slap on the back, the blow was forceful
enough that it seemed more like a Heimlich maneuver than a friendly
pat. The rest of Arnold's department got a less vigorous glad hand, as
was appropriate to their lower rank.

The call came over the PA. a few hours later that evening. I was
still in Emergency seeing cases.

"Trauma! Code Blue! Doctor's parking. Trauma! Code Blue! Doctor's
parking."

"Shit!" I muttered as I sprinted for the door, pulling on a pair of
gloves as I went. Trauma, Code Blue, meant that someone was injured on
the grounds outside. The call could be for anything ranging from a
person having tripped and sprained an ankle to having jumped off the
top of the building. Whatever the problem, it was ER's duty to respond
with a trauma team. I could hear Susanne and some other nurses
following behind with a resuscitation cart.

I ran through the ambulance bay and, once outside, headed to the area
designated for physicians' cars. I felt a cool drizzle against my
face, and it was dark except where the overhead sodium lamps threw down
cones of light that illuminated plumes of mist.

There was nothing in the parking lot except cars, but over near the
wall of the building I saw a small group of people.

It's a jumper, was my first thought while running toward the site.
Instinctively I glanced up the side of the building to see if I could
spot a broken window and estimate the height of the fall. In the poor
light there was nothing obvious. Had they leaped from the roof? That
meant an eight-story drop onto concrete.

Up ahead one of the onlookers spun away from what he was looking at,
doubled over, and started to retch.

I slowed my pace as I approached the scene, braced myself, then
ordered, "Let me through, please."

The dozen or so people standing in a half circle parted, and I could
see the victim. At first I didn't recognize him. I saw only that it
was a man dressed in a raincoat lying facedown in what seemed like a
very large, dark pool of water. His legs were spread out behind him,
his arms raised along each side of his head. It wasn't me pile of
broken remains--usual for a jumper--that I'd expected. Tiptoeing
through the black puddle to get to him, I quickly grew aware mat the
liquid wasn't water, but something dark and sticky, like oil. Yet when
I kneeled down beside the body and was closer to the fluid, even in the
dim light I could see its color wasn't black but dark red. With the
slow motion of a nightmare, I realized I was kneeling in blood, more
blood than I'd ever seen at a trauma site. I felt my stomach rise
toward my throat but managed to keep the burning vomit down enough that
I could warn Susanne and her crew as they came up behind me.

"Watch it! This is all blood."

"My God!"

"Jesus!"

"What happened to him?"

Their horror, evident in their voices, matched my own.
"Get ready to turn him, Susanne!" I quietly ordered, determined to
keep us all on track. As I spoke I slid my fingers around the side of
his neck from behind and felt for a carotid pulse. Instead my whole
hand slid into a laceration the size of ajack-o'-lantern's grin.

"Shit!" I screamed, jerking my fingers back out. The nurses jumped.
Susanne's face filled with alarm.

"His throat's cut!" I exclaimed, fighting as hard as I could to keep
my composure.

"Let's roll him!"

I slid sideways until I was at the top of his head and, swallowing
until I had no more spit, took it between my gloved hands. It moved
like a half-detached soccer ball.

"Oh, God," I moaned, and swallowed a few more times, getting ready.

"All together now, slowly."

As we rotated him around onto his side, his head seemed to have a
floppy movement all its own. It kept wanting to fall backward, opening
up the slash across the front of his neck. No blood spurted from the
gaping ends of arteries or flowed from the dark openings of severed
veins. He'd already exsanguinated.

But the biggest shock came as I brought his white staring features into
view. Awash in blood and underlined by the jagged gash, it was the
face of Hector Saswald.
Chapter 4

The first cop car arrived in minutes. It wasn't much longer before the
parking lot looked like a pinball game of blue and red flashing lights.
A few dozen police officers all tried to take charge at once.

"Stand back!"

"Nobody touch anything!"

"Who found him?"

I was still kneeling beside Saswald, though he was clearly beyond any
resuscitation attempt. I felt I should stay there until somebody took
charge of the body. But the young man who came up to speak with me saw
the half-severed head, exclaimed, "Jesus Christ!" and threw up before
he could get bent over. The orange and yellow contents of his stomach
arced toward the nearby onlookers and hit the pavement at their feet
with a splat.

"That'll move them back," muttered a policewoman who was standing over
me. The crowd proved her right by shuffling away from the rookie who
continued to gag.

An unmarked car pulled up behind me official vehicles, and four non
uniformed detectives piled out wearing look-alike beige raincoats. As
they strode toward us their plain dress was an obvious statement of
rank. The swarm of blue-clad figures milling around immediately made
way for them, then stood by respectfully while the newcomers got a
firsthand look at the carnage on the ground. The policewoman leaned
down to 56 my ear and said, "You'll have to step away from the victim,
but we'll need you to give a statement. Doctor... ?"

"Garnet," I answered, and went to where she'd indicated I should
wait.

She then knelt near Saswald's outstretched arms and shone a flashlight
down on the pavement beside the dead man's left hand.

"Sirs, look at this," she said, glancing up at her superiors.

"There's something written ..." The rest of what she said was lost as
the detectives huddled around her and inspected whatever she'd found.
More vehicles and police personnel were arriving. A dozen people in
civilian dress climbed out the back of a large black van and proceeded
to unload carrying cases much like the oversized tackle boxes used by
medics.

"Shit! Look at the blood!" exclaimed the first of the group to reach
Saswald. His colleagues were already wearing latex gloves, and one of
them immediately started passing more out among the uniformed police.
The others set their equipment down in a circle beyond the perimeter of
the congealing pool, where they proceeded to take out clear packets of
zipper bags, labels, and specimen bottles. A few donned headlamps--the
kind miners wear--and started scouring the area outside this ring. They
all seemed to know exactly what needed doing and worked with a minimum
of conversation.

Much like an ER team, I mused.

A photographer with easily visible police ID pinned to his coat stepped
forward and started snapping pictures. With a wet drizzle coating
everything, the spectacle already had the veneer of a glossy tabloid
photo. One of the detectives hunched over Saswald's right hand
signaled that he wanted a few shots of the ground in that area. The
white flash from the camera continued to cut the night like a strobe.

Station wagons emblazoned with the logos of local TV stations began
pulling into the lot. Soon the area was flooded in the glare of camera
lights as reporters, confined with the rest of the public behind a
hastily erected line of yellow tape, resorted to standing on the roofs
of their vehicles as they got video shots for the eleven o'clock
news.

But as I stood watching, I periodically heard the sound of an ambulance
pulling into the ER garage behind me. Despite the horror on our own
doorstep, there was obviously no respite from the usual injury and
illness going on in the rest of the city. After hearing three such
arrivals, I walked over to the detective who'd been ordering the
photographer around.

"Excuse me, I'm Dr. Earl Garnet, Chief of ER. My team was called out
when the body was discovered. I was told you might need to interview
me, but I've got to get back inside."

As if to underline my point, yet another vehicle roared into the
unloading bay, having cut its siren at the entrance to the hospital.

The man studied me from under a pair of eyelids that drooped with what
looked like years of fatigue, then nodded.

"How long will you be there?" he asked, his voice impeccably neutral.
I suspected it was a practiced tone, one learned at a police academy
and designed to put innocent people on the defensive. To go with his
eyes and manner of speaking, he had a hatchet-shaped face pocked with
old acne scars. In all he resembled one of the bad guys out of a Dick
Tracy comic.

"A few hours," I told him, and turned to leave.

"Hold it. Doctor. I need you to look at something now."

"Hey, I've been standing waiting while four cases have rolled in.
There's only one other staff doctor on duty, and residents don't--" "We
think the victim was trying to write something in his own blood as he
was dying. I'd like you to look at it please."

That stopped me.

"I want to know if you can make something of it," the detective
continued.

"I understand you told the responding officer that the deceased was
head of anesthesia here."

"Yes," I answered, then added, "I didn't see any writing."

"Take another look." The detective stood aside and gestured toward
Saswald's head and outstretched arms.
"Shine a light on the letters," he ordered an officer who seemed to be
guarding the area in question.

The spot he illuminated was about two feet away from where Saswald was
still positioned on his back. At first I couldn't see anything except
some dried streaks trailing away from the leading edge of the pooled
blood.

"Before you rolled him over, that's about where his right hand would
have been," the detective behind me said.

I bent closer, but again couldn't make anything of the marks. For all
I knew, I might have been stepping on them while supporting Saswald's
half-severed head.

"You can see the letters better if you get farther down and look at the
pavement sideways from a forty-five-degree angle," said the officer
holding the lamp.

I did as he suggested, and was about to repeat that I saw nothing when
I made out what could have been a P. Then an e and an r came into view.
Farther along in a line, I could swear I saw a pair ofo's.

"My God, you're right!" I exclaimed.

"Except I can't make out enough to read it."

"Oh, we'll manage that part, all right. We've got a
chemical-luminol--that'll light up traces of blood until whatever's
there will read like a neon sign, in spite of this rain. What I want
to know from you is this: Could a man with his head half cut off remain
conscious enough to even think of scrawling a message, let alone
actually write one? Or is this a greeting from the killer?"

His question forced me to think about Saswald's last moments in terms
I'd rather have avoided. I glanced over at the gaping trench across
the front of his neck, swallowed a few times, and began reasoning
through the answer. The first thing that struck me was that the
killing stroke was probably a single slice with some sort of large
smooth-edged blade, judging from the even demarcation of the cut. Since
it had completely severed his windpipe as well as his carotids and
jugular veins, he'd have been unable to make a noise or cry for help.
If he'd tried, his exhaled air would simply have escaped with a quiet
hiss out the wound instead of passing up through his larynx to the
waiting vocal cords. And each inhaled breath would have filled his
lungs with blood, leaving him choking, drowning bit by bit, again with
little sound. He might have staggered a short distance at first, but
with the massive amounts of blood that would have been jetting out from
his wound he'd have quickly collapsed before getting too far.

I looked around and saw no trail leading up to the pool surrounding
where he'd died. Perhaps after the attack the killer had held him down
until he was too weak to walk or crawl.

But he'd still be conscious. His spinal tract had been left intact,
and the posterior cerebral blood supply would have continued to perfuse
his brain from behind. I recalled a neuro anatomy professor horrifying
us with anecdotal writings that described victims of the guillotine
during the French Revolution.

Even completely severed heads held up to the crowd continued to look
around and move their mouths as if making an attempt to speak.

"Yes, he'd have remained conscious, for about a minute or so," I
replied at last, trying not to think of what terror Saswald felt during
those seconds when he, like the heads held on high so long ago, knew he
was already dead.

For the next two hours I saw patients in the emergency department, but
working was difficult. Images of the near decapitation kept crowding
in on my thoughts and robbed me of my focus.

"... and it was the worst headache of my life, Doctor.

What really scared me was the double vision..."

"... the pain went down the inside of my left arm and to my neck, like
the last heart attack, so I knew..."

"... my entire leg went cold and blue. But it's the pain. For God's
sake help me with the pain..."
Somehow I kept them all straight in my mind, sorted who could go home
from those needing admission, and made the treatment decisions that got
them safely through the emergency room portion of their ordeal. But it
wasn't the art of medicine at its best.

I was signing out to my replacement staff at eleven o'clock when the
triage nurse told me that a big detective was in the waiting room
requesting to see me. Inwardly I groaned, yet continued to walk from
stretcher to stretcher, giving a brief synopsis for each patient that
had been in my care.

Changeover is a time when most errors occur in ER, even under normal
circumstances. But tonight, with the relieving staff abuzz over what
had happened to Saswald, I knew the risk of someone getting distracted
and forgetting what still needed doing was higher than usual. As if to
underline my concern, I kept having to repeat key clinical points two
and three times while the residents scribbled themselves reminders on
index cards or pieces of scrap paper.

When our tour was finally finished--the whole process had taken twice
as long as usual--I watched them stuff these notes into the depths of
their lab coats, the pockets already bulging with manuals, crib sheets,
reflex hammers, and otoscopes.

As a rule, the more inexperienced a trainee, the more junk he or she
carted around, as if it would compensate for what they hadn't learned
yet. By this measure, I judged tonight's crew to be pretty junior, and
warned the overnight physician who'd be supervising them to be
particularly vigilant, especially with those few patients who were
still unstable.

Then, hoping for the best, I bid everyone good night.

Once I got out to triage, I was greeted by a familiar face.

"Hi, Doc," said Detective George Riley. He held out his hand and
stepped forward from where he'd been slouching against an empty
stretcher. He didn't smile, but his shake was firm.

"It's a hell of a thing, what's happened." He was about an inch shy of
my own six-foot-one frame, but more than made up for the discrepancy
by the way his huge shoulders strained at the stitches of anything I'd
ever seen him wear.

Tonight it was his own version of the standard-issue beige raincoat
that he was giving the stretch test to, and from its sodden look I
figured the rain was still coming down outside.

"I'm glad to see you're here," I said.

"In fact, if your superiors have any sense, they'll put you in charge."
Probably no other cop in Buffalo knew the dirty secrets of St. Paul's
better than Riley. We'd initially met about three years earlier, when
I'd become a suspect in a murder case he was investigating.

Since then we'd had an occasion to work on the same side of the law,
and in the process, despite our inauspicious first encounter, I'd
actually grown to like the man.

Now he grinned.

"Looks like at least someone down at headquarters thinks the way you
do. Yeah, for what it's worth, I'm heading this investigation."

"What can I do to help?" I asked.

He breathed out a deep sigh that must have emptied the innermost
recesses of his lungs.

"Lord knows. At this point anything you might think of would be more
than what we've got. Even with so many people seeing him just before
he was killed--your CEO told us about the reception and gave us the
list of who was there--nobody noticed much that was useful.

I was hoping maybe you had. Anything strike you in retrospect that was
odd with the man?"

I shook my head.

"No, not at all."

Riley shrugged.

"That's been the story all night."

"Who else have you talked to?"

"We sent uniformed officers to just about all the medical units to ask
whoever was on duty this evening if they saw or knew anything, but
again, no luck. The scene of the killing hasn't yielded up much
either. The murderer used gloves-there's not a fingerprint other than
the victim's at the scene-and while there are a few bloody footprints,
they don't lead anywhere. Probably whoever it was wore some kind of
boots over his shoes during the attack, then carried them off with
him. We can't even tell at this point whether the killing's connected
to the hospital. Who's to say some creep from the neighborhood didn't
go berserk on angel dust and decide to use your parking lot as a
hunting ground. Dr. Saswald simply could have been in the wrong place
at the wrong time."

"What did the letters scrawled in blood say?"

Riley's eyebrows shot up an inch closer to his hairline.

"You know about that? Christ, you haven't told anyone else, have
you?"

"No, of course not."

He exhaled again, this time a brief, quick breath, the kind that spells
relief.

"Thank God. It's all we have, and for the moment we're holding it
back." He paused, then added, "But since you're already savvy to it,
I'd like to know what you think. Come take a look."

He moved a few steps ahead of me once we were out in the parking lot
and striding toward where Saswald had been killed. The air was much
cooler now, and a brisk wind drove the thin rain into my eyes with
enough force that I found myself squinting as we went. There was
nobody about, my own sign-out having taken me well past the usual time
of shift change when there's always a rush of people coming and going.
I shivered and pulled my lab coat around me, hurrying to stay close
behind the detective. Up ahead I could see a large plastic sheet lift
off the ground as the wind got under it, and about a dozen police
struggling to weight it down by placing sections of metal barricades
along its edges. The opaque covering, obviously intended to protect
the murder site from the rain, snapped and made loud crinkling noises
as it pulled against the restraints, its center rising and falling like
some giant shroud. I felt my stomach tighten at the thought of
Saswald's body possibly still being under it. Surely he'd already been
taken to the city morgue.
After retrieving what looked like a regular flashlight from one of his
men, Riley strode up to one of the barricades and lifted it off a
corner section of plastic. He then quickly folded this part of the
sheet back about six feet and invited me to look at the pavement
underneath.

There was no sign ofSaswald, but I recognized the spot as the place
where I'd seen the traces of letters written in blood.

Except when Riley held his lamp over the area, what I saw now was as
clear as a specimen of graffiti written in green luminous paint.

Behind me I heard Riley start to explain.

"Luminol is a liquid that binds with even the slightest traces of old
blood, and can then be made to fluoresce with so-called black
light..."

But as intent as he was on making me understand the chemistry involved,
the details drifted over my head as I stared down at the words scrawled
across the asphalt.

They read: Pearson... too young... "Does it ring any bells in
connection to Saswald?" Riley asked as I stood over the
strange-looking writing.

"Not at all," I told him without hesitation. But I kept to myself the
uneasiness I felt stir in the pit of my stomach at seeing the name.

While driving home I kept insisting that it had to be a bizarre
coincidence, that the name beside Saswald's body couldn't refer to
David. For one thing, there were too many Pearsons in the world for me
to jump to that conclusion--417 of them had a telephone listing in the
greater Buffalo area alone. I know because as soon as I got to my
house that night I took out our directory and counted them. For
another, as far as I was aware, the only thing the two men had in
common, besides knowing me, was one being a patient at a Brama clinic
and the other working for the company itself. And whatever contempt I
felt for Brama, I couldn't make that connection between the two men
into anything other than a matter of
chance, and one not all that remarkable either, given the size of the
corporation and the huge number of patients and doctors in the area
already doing business with the place. Besides, David was in Mexico,
so why would I even think he had anything to do with the killing? Yet
it was eerie that my last conversation, and quarrel, with Saswald was
in effect on account of David Pearson.

While I'd been busy with the phone book, Muflfy made it pretty evident
she wanted to go out, dancing and twirling at my feet. Listening to
the quiet upstairs, I knew the rest of the household was asleep. My
own brain was far too jangled to even consider going to bed yet, so I
decided I might as well take her for a walk. I found her leash,
attached it to her, then stepped outside. It had stopped raining, and
after taking a few lungfuls of the fresh night air while she tugged me
along our back lane--one of the few in Buffalo--I got clearheaded
enough to realize how lucky it had been that I hadn't used David's name
when asking Saswald about the addiction clinic.

Otherwise someone might have reported overhearing it and the police
would have been all over me with questions about the man, trying to
connect him to the name beside the body.

The lane I was following with Muffy had once been a side road used to
access a country golf course, before urban sprawl brought houses to the
edge of the fairways. It led between the back of houses and was lined
by fences, hedges, and gardens. As she found her points of interest, I
would have normally enjoyed the places where I could see into my
neighbors' gardens. Instead I found myself thinking about what the
rest of the writing beside Saswald's body could mean. Too young... Too
young for what? The common completion of that phrase--to die--popped
into my head. Had Saswald or the killer been trying to write Pearson
... too young to die...?

If it was written by the killer, why didn't he finish? Lack of time?
Maybe, though two or three seconds more would be all he'd have needed.
But ifSaswald wrote it, why would he be so desperate to say someone
named Pearson was too young to die? Guilt perhaps? Over a case he'd
botched? Had he been killed for that, and tried to write a form of
confession as he went? The image of him struggling to confess some
fatal error as the life poured out of him sent a shiver through me.

Up ahead lay the tenth green, far from the clubhouse and security
guards. It was where I sometimes ignored the no dogs sign and let
Muffy run free if it was late enough that we were unlikely to be
reported by other walkers or busybodies peeking out of nearby windows.
As we got nearer she grew increasingly excited, tugging on the leash
until I could barely hold her. We crossed onto the grass and, as was
our ritual, came to a standstill in the shadows of the tall pines
lining the course. Muffy quivered and made little whining entreaties
while we scanned the area. The grassy expanse was full of nothing more
than moonlight and a few white trailing wisps of fog. Overhead the
breeze made soft hushing sounds through the bows. Somewhere in the
distance an owl hooted.

"We're in luck, girl. The place is deserted," I whispered, reaching
down and releasing her.

She raced away, a streak of black on silver tracing ever widening
circles through the dew-covered grass. While I watched, envious of her
happy abandon, I tried to quell all thoughts of cryptic messages and to
shove coincidences that gave me the creeps out of my mind.

Half an hour later I was back home and slipping into bed beside Janet,
trying not to waken her. I thought I'd cooled my mind enough that I'd
be able to fall asleep.

But then the bad dreams came.

I was walking toward where the killing had occurred, and the area was
covered with the large opaque sheet undulating in the wind that I'd
seen earlier. Except this time I knew Saswald's body was still under
there--its dark shape visible through the plastic shroud which
continued to rise and float downward. I tried to stop from going any
nearer, but was propelled forward against my will. When the corpse was
at my feet, the wind suddenly gusted and whipped the covering from off
the ground and wrapped it around my legs. Tangled in its folds, I
couldn't budge, couldn't get away from Saswald's uncovered face staring
up at me, his slashed neck gaping open.

Then his lips began to move, mouthing, Pearson ... too young... I woke
up in a sweat, my scream only half out of my throat and Janet shaking
me.

"It's okay. Earl, it's okay," she was saying in a soothing voice.

But Muffy thought otherwise. In the semidarkness I could see she was
on her feet straddling my legs. She must have sensed my very real
fear, because she threw back her head and howled.

Janet had already learned about the murder when she'd called the case
room earlier in the evening about one of her patients. Whatever gory
detail the nurses there had left out, she'd seen later on the TV
news.

"I know it's hideous, but there's no point talking further about it at
two in the mo ming she declared after we'd gotten Brendan back to
sleep, and I'd reassured the nanny, who slept in the attic room, that I
rarely had nightmares so she'd probably make it through the rest of the
night without me setting Muffy off again.

By five, after sleeping only fitfully, I was awake for good and
thinking of only one thing: I wanted to get back to the hospital and
dig out the charts of every patient named Pearson, living or dead,
who'd been admitted to St. Paul's since Saswald first came on staff.
Deciding I might as well put my sleeplessness to use, I stole out of
bed. Muffy immediately hopped up to fully occupy my vacant place with
a languorous stretch.
It was still dark when I walked outside to get my car, and my breath
showed white in the early morning frost. Overhead in the fog I heard
the leaves of fall rustle in the breeze, and the moist coolness of the
air felt like a shot of aftershave against my face. But I was much too
uneasy about what we might be up against to pause and savor these
sensations.

Once I was on the road, my driving along the familiar route was
completely automatic. The glare from my headlights made a spotlight
that sped over the asphalt while I chased behind it, lost in thought.
Attacks against physicians were becoming all too common these days. As
a chief of emergency I'd always had fears that my staff were especially
vulnerable. The sick est people--the ones most likely to die--usually
came through ER, and to an insane mind I figured we could be regarded
as the starting point of someone coming to grief in a hospital, no
matter what specialty they were ultimately admitted to. So if some mad
avenging angel had set up shop in the neighborhood, I wanted to know
about it.

The physicians' parking lot had only a few vehicles in it when I
arrived at St. Paul's. I pulled up between the lines of a painted
slot, shut off my motor, and sat there looking at the spot where
Saswald had had his throat slashed.

Nothing remained around the the plastic sheet but the ring of metal
barriers and strips of police tape warning a passerby not to cross
over. Except here the wind, roaring in off Lake Erie, then
accelerating through the concrete canyons of the downtown core, was
much gustier than it had been in the suburbs, and the strength of it
had ripped apart the yellow strands, turning them into streamers.
Sitting there in the driver's seat, I watched these trail up into the
night, where they coiled and snapped above the killing site, guarding
it like some tentacled creature made of giant ribbons. Around it
swirled the flotsam of a crime scene, discarded Styrofoam cups and bits
of crumpled paper--sweeping this way and that in the eddying
currents.
Feeling my own car shudder under the buffeting it was taking, I braced
myself to cross the deserted terrain between me and the nearest
entrance to the hospital, took a breath, and opened my door. A
particularly strong blast caught it and wrenched it out of my hand
after half dragging me out of my seat.

"Shit!" I exclaimed, grabbing the steering wheel so I wouldn't fall,
then pulling myself upright. When I did step out of the car, the hem
of my unbuttoned overcoat whipped and flapped around my legs so much
that I had to turn my back to the onslaught and do up the remaining
buttons before I could walk. As I turned to go, a solitary sheet of
newspaper flopped and writhed its way past me, then pasted itself
against one of the tires.

The distance to the hospital was a stroll of about a hundred yards, a
trek I made on a daily basis without ever giving it a thought. At this
early hour, huddled against the bursts of icy air that hit with the
force of a wave, I found myself watching in every direction as I
scuttled over the open space, feeling much like an animal on the
lookout for some beast of prey. I wasn't quite running, but was close
enough to it that my breathing started to quicken. I also kept looking
back at the murder site, illogically afraid to take my eyes off it, as
if anything there could hurt me. Except this time I saw the large
plastic sheet slowly well up in the middle, fill with air, then
deflate, just like in my dream. With a shiver I focused my eyes
straight in front of me as I walked toward a well-lit entrance that now
lay forty yards ahead. It was darker in this stretch, in the shadow of
the hospital looming above me on my right and well beyond the range of
the sodium lamps behind.

My lone footsteps were louder here, the slap of leather sole against
wet pavement echoing up the brick sides of the building, the hollowness
of the sound giving measure to its height. Along the base of that
wall, between a series of Dumpsters parked in a row, were many shaded
recesses, and I found it hard not to imagine the killer lurking in one
of them before he'd come up on Saswald from behind.

I broke into a trot.
The door was about thirty yards away and I was adjacent to a
particularly dark alcove when I saw a glint of metal about chest high
wink at me from its inner depths. An instant later I made out the
figure behind it, but even then it was more a movement than a
form--black sliding through black--as whoever it was came toward me.
Chapter 5

My panic rocketed.

"Back off!" I screamed at the shape approaching from the side, and
broke into a sprint for the hospital entrance. Before I knew it
another silhouette had stepped out of the shadows in front of me,
blocking my way, while the man behind bellowed for me to stop.
Desperately I cast around for a place where I could run. Twenty yards
to my left the hospital property abutted a large empty lot. It was
full of weeds, litter, and low scrubby bushes, but it was the only
option I had. I pivoted and headed toward it. Now both men were
bellowing that I stand still, and out of the corner of my eye I saw the
one who'd cut me off reach inside his raincoat. Jesus, I thought, he's
got a gun! If I made a racket, maybe there were still some cops
around.

"Police! Help! There's a man with a gun!" I hollered, and found
speed I never knew I possessed.

I was already at the curb and into the abandoned terrain when the beam
of a flashlight caught me and a voice roared, "Wait! We're the Buffalo
P.D.! We're not going to hurt you!"

Sure! I kept running.

"Is that you. Dr. Garnet?" the same voice demanded.

I pulled up and turned around to face the source of light.

From behind its point of origin a man said, "I thought I recognized
your voice, even with all your yelling. I talked to you last night,
remember? I'm the detective who asked you whether the victim would
have been able to do the writing we 51 found beside his body. I'm
sorry for scaring you." As he approached he spoke in Ac same
matter-of-fact tone he'd used at our first meeting and swung the light
around to illuminate his own distinctively lean face. The severe angle
of the beam exaggerated his acne into a moonscape of shadowy craters.

His partner--a much younger man, from what I could see of him--followed
behind but said nothing. Enough light spilled his way that I could
make out that he was a uniformed officer, and I saw that the glint of
metal that earlier caught my eye had been his badge.

My terror quickly changed to anger.

"Scaring me!" I yelled at him.

"You practically gave me a heart attack." Pointing to the younger man,
I demanded, "What the hell were you hiding like that for? I took you
for the killer. And as for you," I exclaimed, focusing my fury on the
detective, "when I saw you reach for what could have been a gun--"
"Whoa, Doctor, now you listen to me!" he cut in, his tone now
hostile.

"Detective Riley ordered us to watch the area from where we wouldn't be
seen. A couple of cops sitting in an unmarked car stick out like a
sore thumb, so we stood around in those shadowy areas instead, to stay
out of sight and be away from the wind. Frankly, we'd been figuring it
was a total waste of time, until you showed up." He pointed a finger
at me.

"You were acting pretty strange, you know, spending all that time
sitting in your car, staring at the scene of the killing, then running
over here and surreptitiously looking around. I couldn't see your
face, and, well, what do you expect us to think?" He shrugged, holding
his palms to the heavens, as if someone up there would get his meaning
and pass it on.

"Suppose you tell me," I snapped.

"Your behavior was suspicious as hell," he fired back.

"I

thought you were the murderer returning for more."

My resentment against me man shot up another notch, and I made no
effort to conceal it.

"Detective, surely it's possible for a competent policeman to
interrogate someone who raises suspicion without scaring the innocent
out of their skin. If you thought I was the killer, why didn't you cry
out "Police!"

right away, and then question me?"

The two men looked uneasily at one another but said nothing.

"Well?" I pushed.

"Why don't you explain?" the uniformed officer said.

There was a hint of anger in his voice, but whether it was directed at
me or his partner, I couldn't tell.

The detective's eyes shot a warning at the younger man.

Then he heaved a sigh and turned to me.

"Because, Doctor," he began, his impatience obvious, "everyone who
wandered through here tonight claimed they had something wrong with
them medically--the runs, a headache, bronchitis--and that they were
coming to Emergency for treatment. Now all these people sounded legit
once we talked with them, and none of them got my sensors going, but I
began to realize that if we ever did roust the killer for being around
here, it would be too easy for him to make the same claim. Much
better, I thought, would be to see how he reacted to someone coming out
of the dark. If he went into battle mode and pulled a knife, for
instance, we might have both a suspect and a murder weapon. So I
figured, why not delay saying we were the police for a few seconds, in
the hope of panicking him into revealing his true colors? Now, of
course I wouldn't have pulled that move unless I already had cause to
think the worst, and unfortunately, you fit the bill. But as soon as I
saw how freaked out you were, I realized you weren't--" "Wait a minute.
You mean your scaring me like that was deliberate?" I could feel a new
flush of anger spreading across my face. Up until that moment I'd
figured they'd just been stupidly thoughtless.

He gave me a sullen stare, and then with a shrug replied, "Like I said,
you behaved strangely, and I couldn't see your face."
His partner grimaced and averted his eyes. Of the two, he looked the
more miserable.

Maybe I should have made allowances. Perhaps if the detective had been
less obnoxious I might have been more understanding, seen his point of
view, even reassured him that I understood his obligation to suspect
any oddity that came across his path, or to adopt any means he
considered necessary, including cutting corners, if it meant capturing
Saswald's killer. But I said none of those things.

"Listen, hotshot!" I growled instead, jabbing my finger at him,
"before you resort to 'freaking out' anyone else tonight, let me advise
you to get used to the fact that this is a hospital. Then you can get
used to the fact that there will always be patients coming and going,
no matter how inconvenient that may be for your so-called police work.
Let me further warn you that the next person through here could be on
their way toER for what they think is indigestion but is really a heart
attack, and you could literally frighten a person in that condition to
death. If you try any more stunts like this one, I'll have Detective
Riley ban you from the premises!"

He bristled at the rebuke, and in the ambient light from his flashlight
I could see his pupils widen in anger. But he must have seen something
in my face--I thought I'd snap a crown, my teeth were so tightly
clenched--that convinced him he'd be better off to say nothing. After
we'd breathed at one another a few more times, he wheeled around and
strode back toward the parking lot, signaling his partner to follow.

Lord help us, I thought, watching the two men walk away. I knew from
experience that whenever the police became involved in investigating a
crime in a hospital, even when they were on their best behavior, there
were inevitable clashes between their priorities and those of the
patients and doctors.

It would be rough enough around here until the killer was caught
without the cowboy antics of an overzealous detective.
* * * Five minutes later I was in Medical Records, determined to
follow through with my plan despite the nasty encounter.

There I discovered that another of Riley men had kept one of our clerks
up all night gathering the very information I wanted to see. At the
officer's request, the clerk had pulled the files--eighty-two in all,
including eight that were marked deceased--of every patient with the
name Pearson who had been to St. Paul's at least once since Saswald
came on staff ten years ago. Except the clerk hadn't let the officer
look at them. Instead she rightly insisted that he must have proper
authorization first--"Medical confidentiality takes precedence even
over a homicide investigation," she told him sternly, much to his
annoyance--and had placed them in the hospital vault for safekeeping.
Yet she didn't have a problem with showing them to me. As a member of
staff and Chief of Emergency, I was used to getting any record I asked
for. She only requested that I speak with the detective in charge
first, for her own protection.

Riley readily agreed with what I had in mind.

"Frankly, your going through those records right now would be a big
help. We filed for a warrant to look at them, but with so many--and
our sole criteria being that they belong to people named Pearson--the
judge delayed a decision until he's sure he won't get patients' rights
groups on his back. You know, cops leading a fishing expedition
through medical records-that sort of thing. Not that I'm surprised.
Hell, it's always tough bringing medical files into a police
investigation."

As it should be, I thought. Every now and then Riley unwittingly
reminded me that he and I sometimes worked opposite sides of the
street. I thought now was a good time to remind him of that.

"You understand, if I do find anything incriminating on a patient,
medical confidentiality dictates that I won't be able to tell you about
it either. You're still going to have to wait for official approval
from your judge."

I heard him sigh.

"Come on, you know the rules," I continued.
"What I can tell you, however, are negative findings. If none of them
ever saw Saswald as a patient, I don't feel bound to keep that from
you. But should I simply report 'no comment," then you better move
your tail and go after whatever warrants you'll need to get a look at
those records yourself." It was awfully close to crossing over the
line of what was ethical, but given what might be at stake--stopping a
killer, especially one who might have an agenda against hospital
staff--I knew it would hurry things along, and I was comfortable doing
that.

"Fair enough," he answered.

"But since we're setting terms, I remind you of mine. While we're
asking if Saswald knew anyone named Pearson, we still aren't making it
public that the name was written in blood by his body. Make sure you
continue to keep our little secret."

"Got you," I assured him.

Seated at a rickety table set up in the vault itself, it took me an
hour and a half to look through all the files. They ranged from the
very thin--documents of a onetime visit to Emergency or a clinic where
the patient had contact with only one physician--to massive
multivolumed charts, each section an inch thick, each showing a
patient's many admissions where he or she was under the jurisdiction of
numerous doctors.

Riley's man, slouched in a chair he'd propped against the massive steel
door, looked on from the entrance as I worked.

When I came across David's files, besides confirming what I already
knew--that he'd never been treated by Saswald--I used the opportunity
to note his physician of record at the time he'd been transferred to
the clinic in Mexico. I saw from the progress notes that when he left
I.C.U, he was declared physically stable by Dr. Arnold Pinter, but
that he spent his final few days at St. Paul's under the care of
psychiatrist Dr. Peter Forbes. I knew Forbes was in charge of
psychiatric admissions through Emergency this month, and having signed
off on the transfer to the Brama clinic, he was the one most likely to
receive an update of his former patient's progress. I'd call him
later in the day, I promised myself, and ask if he'd heard how David
was doing.

At 6:55 I flipped through the last chart, tossed it on one of the piles
I had spread out in front of me, and leaned back in my chair for a
stretch. The good news was that Saswald had never maimed or killed
anyone named Pearson in all his years at St. Paul's, because he'd
never had anybody with that name as a patient. The bad news was that
all the alternative scenarios would now have to be considered.

I started ticking some of them off on my fingers. First, an avenger
named Pearson was righting wrongs that he believed had been done to a
patient of another name. Second, that the basis of why Saswald was
killed might lie in some personal relationship he'd had with a man or
woman named Pearson who was completely outside medicine. In that case,
nothing in any medical file would reveal their identity, nor would the
endless interviews with St. Paul's personnel that lay ahead.

The police would have to track down God knows how many leads outside
the hospital, presuming the name Pearson even applied to someone from
Buffalo.

As I mulled over the magnitude of what might be involved in finding the
killer, an even worse-case secenario popped into my head. What if the
speculation that the killer himself left the message was correct, as a
false lead to throw the police off track? All he'd have to do was dip
Saswald's hand into the blood and then use it to scrawl the name of
someone else who could be blamed. Hell, he might even have made the
name up, and the authorities would be pursuing a person who didn't
exist.

I stopped counting the problems. They seemed so vast and
insurmountable that I shuddered at the job that lay ahead for Riley. If
his work was always this daunting, it was little wonder he looked so
worn-out.

A glance at my watch told me it was nearly time to get downstairs and
meet the residents for teaching rounds. I pushed away from the table,
groaning with stiffness as I got up. The sound startled the officer
awake--he'd nodded off about an hour after I started--and though he was
still pretty groggy, he made sure I hadn't taken anything I shouldn't
have, while I watched to see that he didn't sneak a peek at anything he
wasn't supposed to. Together we then shoved the huge door shut,
double-checking that the locks had clicked home after we'd each given
the dual combination dials a twirl. Heading for the stairs, I called
over my shoulder, "Tell Detective Riley to reach me in ERAs I descended
a question floated to mind the way a small mound in the middle of a
flat expanse becomes significant, or a speck on a white sheet is at
once noticeable. Could the coincidences that I'd been trying to
dismiss last night--David Pearson, the Brama clinic, my question to
Saswald, even the testiness of the anesthetist's response--be more
important than I'd previously thought? Possibly. But what to do about
it?

By the next landing I was wrestling that one around a bit.

On one side was my personal reluctance to say anything and my
obligation not to reveal a medical history. On the other was my
dawning realization that even though David was in Mexico, he might have
had some connection to Saswald that I had no idea about. But again I
was faced with how to find a way to say anything about the coincidences
without somehow treading on my obligations to David under a doctor
patient relationship.

Midway to the second floor I passed a window where beads of water were
starting to run down the outer panes of glass, obscuring my view of the
asphalt expanse below. All I could get a glimpse of were the blurred
figures of people emerging from vehicles in the parking lot and racing
to the nearest entrances. A line from an old song by The Doors shot
through me like a chill. Except the words became "Killer in the
rain."

I taught for an hour, then saw patients for an hour, but during that
time the presence of the police became more and
more visible. We'd learned from the overnight nurses that
investigators had continued questioning people--unit by unit-until
about four a.m. By now it was well-known that the police kept bringing
up the name Pearson during their interviews, but so far, according to
the gossip I heard, nobody knew why.

I assumed from the influx of blue uniforms that Riley had summoned them
to help interrogate the much larger day shift.

Soon they were leading our own nurses away by twos and threes, and the
sergeant in charge told me orderlies and residents would follow. He
made a compromise with the staff doctors, agreeing to take them only
after their shifts ended.

Although each interview barely took more than ten minutes, the
ceaseless comings and goings of different staff groups to be questioned
was both disruptive and a constant reminder of what had happened just
outside our door.

It was all too distracting.

As a result, everyone seemed to be taking longer than usual to process
patients through ER. Even with the lighter load resulting from Brama's
boycott, the waiting room was soon so backed up that people were
spilling over into the ambulance bay. Then we had a ruckus when an
orderly accidentally switched two charts and a woman trying to sleep
off the effects of an alcohol hinge suddenly found herself being
propped and shaved for an appendectomy. While I was trying to calm
down the indignant lady, her husband--a bearded giant of a man--kept
screaming, "She got no pussy now!"

Next, shortly after nine-thirty, we had a major medication error.

"Hold it!" I heard Susanne shriek in the curtained cubicle next to
where I was working. I stuck my head in to see her yank a still filled
syringe from the rubber side portal of the patient's IV From the
startled expression on the face of a second nurse, who was still
holding the intravenous tubing, I assumed she'd been about to inject
whatever Susanne had snatched from her.
The patient, a very pale, frightened-looking man of middle years who
had blood running out of his mouth, cried out, "What's the matter?"

"You're going to be fine, sir," Susanne assured him, patting his chest
with her free hand while his eyes darted to each of us. She then
picked up the empty vial of whatever medication was in the syringe and
turned to her protege.

"Outside!" she ordered, stepping between two curtained panels. Her
flushed colleague followed, and I heard Susanne start in even before
the two woman were in private, which wasn't her usual way of
reprimanding one of her staff.

"That was potassium, not vitamin K--" A door slammed, cutting off the
rest of it, but I'd heard enough to make my blood run cold. Oh, God,
no, I thought, continuing to try and calm the man in front of me.
Already pretty certain that I knew what had happened, I grabbed his
chart from the head of the bed and found the order sheet. Sure enough,
he was on anticoagulants and had begun hemorrhaging from a stomach
ulcer. Instead of preparing a bolus of vitamin K for injection into
his veins--the treatment to normalize clotting in the presence of
warfarin--the nurse had drawn up a syringeful of potassium, an agent
also symbolized by K+, but one that would have stopped his heart cold.
Since the needle was already in the patient's IV tubing, I assumed that
Susanne had recognized the empty vial on the counter nearby and caught
the mistake just as her colleague was about to push down on the
plunger.

"We'll be stopping that bleeding in minutes, sir," I managed to say,
barely able to maintain my usual it-will-be-all-right tone, which I
kept for situations hurtling out of control. But get it stopped we
did, after vitamin K restored his coagulation and a naso gastric tube
decompressed his stomach.

"I hope you catch this nut fast, but you also better rein in the
cowboys on your team," I warned Riley after explaining to him what had
happened to me in the parking lot. It was
mid-mo ming and we were having coffee together in my office.

"If you don't, everyone at St. Paul's will either be too jumpy to
function or at war with your investigators. I just spent an hour
getting my own staff settled down, but I tell you, it wouldn't take
much to screw up their concentration again."

He was seated across my desk, sprawled in the only chair I had for
visitors. His coat was more rumpled than usual, and the stubble on his
face gave testimony to his having worked all night. He'd made no
comment while listening to what had happened to me in the parking lot,
but by the way his jaw muscles bulged with tension, I knew he'd soon be
giving the detective in question an attitude transplant.

"As far as how my search through the charts went," I continued,
"unofficially I can tell you that there's nothing overt in those
records to connect any patients named Pearson to Saswald." I then told
him some of the alternate scenarios that had occurred to me.

After hearing me out, he leaned forward with a bemused look on his
face.

"Believe it or not. Doc, I actually came up with most of those same
possibilities all by myself." But the hint of a smile was short-lived
as his face creased into a frown.

"You're right about one thing. Tracking down that name is going to
take an army of cops, wild goose chase or not." Discouragement seeped
from his voice.

"By the way, did you know Saswald's family?"

I shook my head.

"I've said hello to his wife at a few social functions, but I have to
admit I'm not even aware if he had any children." It was often that
way with doctors working together in a large hospital. We were
acquainted through our work and often had intimate knowledge of one
another's professional skills, for better or worse, but with a few
exceptions, the minute we walked outside these walls we were
strangers.
"I spoke with her last night," Riley said, after downing the remains
of his coffee with a single swallow. He sat motionless for a few
seconds, staring into the bottom of his empty plastic cup.

"I don't know how it is for you, but talking to a family member after a
loved one's been killed... well, I find there's nothing harder."

I knew what he meant, but said nothing.

"A very stoic woman," he continued, looking up from the dregs of his
drink. I was struck by the sadness of his gaze, and recognized in it a
darkness that was common to the eyes of older cops. I'd watched the
same expression become etched in the faces of veteran ER doctors who'd
borne too many of the inevitable losses that went with practicing
medicine on the near and already dead. Lately, especially since the
time of Brama and an increasing number of cases like little Robert
Delany's, I'd started seeing a similar look staring back at me from my
mirror whenever I'd spent more time than I should in the pit. What we
shared in our two very different jobs, I suspected, was the burden of
memory--from a lifetime of witnessing how people lived and died in a
major city.

"She insisted on speaking to me as soon as possible," he went on,
"despite the shock of her husband's death. But she hasn't any idea who
Pearson is either. We ran into the same blank wall with his staff
members. We're still checking with that outfit named Brama that he was
going to work for, but so far no one over there has been very helpful.
Saswald's children, a son and daughter, both married, are flying in
from out of state, but I doubt they'll add much or will know who
Pearson is. Mrs. Saswald intimated that her late husband had let work
get in the way of his having time for them when they were kids. Now
that they're grown with children of their own, they've had little time
for him." He stood up with a groan and arched his back, his large form
making my cramped work space seem even smaller.

"Man, I'm getting too long in the tooth for these all-nighters. It'll
take a week's sleep to set me right."
I knew he was about ten years my junior, yet the heaviness in the way
he moved made him appear much older. As he reached across my desk to
shake my hand before he left, I could sense the depth of his weariness
and doubted it could ever be entirely erased by sleep.

I don't know if it was the sudden flash of empathy I had for the
detective or the overwhelming odds he'd just painted against us ever
finding the killer that spurred me to think of it, but all at once I
saw a way to narrow down the investigation for Riley that wouldn't
violate any medical confidences. Why not simply suggest he look into
Saswald's connection with the clinic--because of the anesthetist's odd
reaction to my question about it--and not mention David at all. The
idea struck me as so straightforward that I blurted out, "Wait a
minute. There was something strange that happened at the reception
which maybe you should know about."

Already halfway out the door, he turned, his eyebrows curling into
question marks.

"When you interview people at Brama, inquire about Saswald's connection
to an addiction clinic they run in Mexico. When I asked him about it
last night, namely if he'd worked there, he became quite defensive and
we got into an argument."

He stood looking at me expectantly. After a few seconds he said,
"And?"

"That's all. I think you should look into what was behind him getting
so upset about that clinic."

His expression grew even more curious.

"What makes you think that might have anything to do with his being
killed?"

"No specific reason, other than it seemed strange--such a hostile
response to an innocent question."

"What exactly was your 'innocent question' about this clinic?"

"Nothing more than asking had he come across it in his work? Did he
know anything about it? That kind of thing."

"And why did you want to know?"
Whoops!

"Uh, well, I had heard about the place and wanted to know what it was
like--" "Why?"

I was beginning to feel uncomfortable.

"Look, that's not the point. It's the man's reaction--" "Look, Doc. I
know you're trying to be helpful, but the fact that you asked the
deceased about some addiction clinic and he got pissed off at you for
it doesn't exactly sound relevant to the man's murder."

I felt my stomach start to tighten.

"Well, maybe you're right. But I thought since you asked me about
noticing anything odd--" "Doc, you're not a good liar, and I've been
around you enough to know you don't make suggestions that aren't well
thought-out. There's got to have been some other reason that made you
think Saswald's reaction to your question about a clinic was worth
mentioning in the first place."

"Why, that's not so--" "Level with me," he ordered, sounding almost
gentle while the lines in his forehead deepened.

"Why won't you tell me why you asked Saswald about that clinic?"

"I swear, there's nothing I'm keeping from you--" "Cut it out!" he
barked. His sudden change of tone made me jump.

All at once I felt a nearly irresistible urge to come clean as he
stared at me, his brow gathered further into a frown. Shit! I
thought. I should have just kept my mouth shut. Well, there was
nothing to do now but claim doctor-patient confidentiality, but I felt
as uneasy as if I were about to plead the Fifth.

"I'm sorry. Detective. I can't tell you why I asked about that clinic
except to say the reason involved a patient of mine--" "Patient? Wait
a minute." He came a step closer, the fatigue in his eyes instantly
vanished.

"Is this the 'no comment' we agreed upon?" His gaze now bore into me
with the glare of floodlights
"Not exactly," I cautioned, holding up my hand--palm out--to slow him
down. I was determined to keep control of this conversation and not
inadvertently let something I shouldn't say slip out.

But Riley wasn't about to be slowed.

"Then what is it exactly, Doc? If I can't see what's so important
about you and Saswald having a quarrel over a clinic, what am I missing
here? Or as I put it before, what are you holding back that made you
think the incident was important?"

I started to squirm under his thousand-watt gaze. This wasn't at all
what I'd intended.

"As I told you," I countered, sounding unbelievably stiff, "I can't say
anything more because my question about the clinic concerned a patient.
But the patient had nothing to do with him getting upset. I never
mentioned the patient. It was the clinic--" "Shit! That patient of
yours wouldn't be among the charts you just checked, would it?"

I felt myself flush. Desperate now to enforce the rules of medical
privacy, I declared, "Detective Riley, I cannot reveal--" "A patient of
yours, not Saswald's, named Pearson? Now Saswald having a quarrel
about someone called Pearson just before he died, that's pretty
interesting."

I jumped to my feet.

"Damn it, man, will you listen?" I demanded, jabbing at him with my
finger.

"I didn't say we had a quarrel over a patient named Pearson. I never
told him the patient's name, period. That's my point. His hostility
arose when I questioned him about the clinic. It occurred without him
knowing I even had a patient connected to the place, so focus on it My
voice had risen to the point of yelling.

"Find out what the hell made him defensive about the facility!"

But Riley had become unstoppable.

"Oh no. Doc, it's the name Pearson that's got to be the link here, and
now I think I can see what you've been trying. to tell me."

"But--" "You inquired about the clinic on behalf of a patient named
Pearson, didn't you. Doc? And Saswald reacted angrily to those
questions. Then you saw the last name of that patient scrawled by
Saswald's body. Did I put it together correctly?"

"Damn it, Riley, get it through your head. I didn't say Pearson was my
patient's name--" "Hey, it's okay. Doc," Riley interrupted, his voice
chillingly quiet all of a sudden.

"You don't have to say anything more. I know what to do now, and
thanks."

Before I could sputter out more protests, he was gone.

I sat there a long time, feeling disgusted with myself. Why hadn't I
just kept my mouth shut? Then if the police had eventually gone
through David's file, the fact that he was at the Brama clinic wouldn't
have meant anything to them. They probably would simply have thought,
as I initially had, that since he was in Mexico at the time, it was
unlikely he'd had anything to do with the murder.

But now? I didn't even want to think about what I might have set in
motion.

"Shit!" I muttered, burying my head in my hands.

"Shit! Shit! Shit!"

Thirty minutes later, having been unable to think of anything else but
David and what I'd probably done to him, I left my office, knowing I
had to get a warning to the man.

After all, Riley would now move mountains to get into the files
upstairs, and single out David in no time, what with my having primed
him to consider that the clinic might be connected to the killing. Now,
David having been a patient there would not provide him with an alibi,
but instead would deem him in the eyes of the police as a man to be
viewed with suspicion.

Questions would be raised. Was David connected to Saswald? Had he any
reason to want Saswald dead? Could he have organized the slaying? I
shuddered and wondered how the police coming to him so early in the
investigation, especially since they had nothing else to go on, might
change their treatment of him or their diligence in pursuing other
leads.

Not that I thought they'd deliberately railroad David into anything.
But after seeing how Riley had seized on the information I'd given
him, it was pretty clear he'd make the most of it, and that meant
trying to establish a link between David and the murder. The worst of
it was, I could have predicted exactly all this if I'd only thought
things through before making my brilliant disclosure.

Dr. Peter Forbes, the psychiatrist who'd taken care of him, was
referring to a sheaf of papers while speaking into a Dictaphone when I
knocked on his open door.

"Why, Earl, this is a surprise," he declared, looking up from his
work.

"Come in.

You don't visit this neck of the woods very often." He was a
middle-sized man of middle age, balding, round-bellied, and in need of
an orthodontist, but he dressed in suits that I only ever saw in
fashion magazines. It was hard to believe, but the rumor around the
hospital was that the ladies found him sexy.

As for me, I always found it strange that a man specializing in
addiction looked like a mini version of Bacchus.

"Thanks, Peter. I'm not disturbing you, am I?" Forty-five minutes had
lapsed since Riley had raced off, probably already revving up the
process that would eventually put David in his sights. I had no idea
how long that would take--hours, days, more perhaps--but I had to
hurry.

"Of course not. Here, have a seat." He gestured across his desk to a
pair of overstaffed sofa chairs upholstered with maroon-colored silk
and embroidered in gold braid.

A doctor's office, especially one provided by the hospital in which he
or she works, can reveal a lot about the person and their status in the
institution. Forbes's was no exception.

His domain was twice the size of mine, and his furniture, made of
laminated rosewood, was clearly superior to the metal issue I'd been
provided with. His carpet was soft blue in color and, though half an
inch shorter than the stuff in our CEO's suite, was a far cry above the
gray linoleum that paved my work space. From what I'd learned after
twenty-two years of observing such matters, I'd rank Forbes's place as
being of middle importance--not a figure of national or world academic
stature, but someone who was nevertheless of use to the hospital--at
least in the minds of whoever decreed these things at St. Paul's. The
reasons for the psychiatrist's claim to this modest title--several
hundred articles he'd written over the years--were on display in the
bookcase lining the wall behind him. He'd arranged them in rows with
the covers facing out so they'd all be in full view of anyone seated in
his visitors' chairs, one of which I'd just settled into. The collage
effect was overwhelming, but none of the journals in which they
appeared were mainstream publications.

Rather, they bore such titles as Pharmacology Weekly or Psychotropic
Drug Bulletin and were the literature of what I called "me too"
research--attempts of pharmaceutical companies to make small changes to
a competitor's product in order to market it themselves.

When he saw me regarding these stacks that contained his life's work,
he tapped the notes in front of him on his desk.

"Number ten in twelve months." He beamed, laying aside the microphone
into which he'd been dictating his latest epistle.

"You know, I could throw some contracts toward your department.

Drug reps are drooling to claim efficacy for a medication specifically
tried in ER these days--TV has made your turf very sexy--and the extra
money could keep you in defibrillators for a good while."

Even new medication that's only intended to increase market share needs
clinical trials, and that's what he was suggesting I participate in.
Through them, Porbes and his kind would sometimes catch unexpected side
effects in a redesigned chemical that would have cost the company
involved a bundle in lawsuits. The drug industry showed its
appreciation for these "saves" by lavishing grants on the participating
hospital, to cover such expenses as Forbes's office and the chair I was
in. Up until a few years ago the man also had profited handily in a
personal way--what with expensive junkets and lavish accommodations
provided to him and his family for attending so-called scientific
meetings--but then the Food and Drug Administration had regulated
against such perks.

"I'm afraid my plate's pretty full as it is," I politely declined, not
wanting to insult him with what I really thought of his "studies."
After a few more pleasantries, I went after what I needed to know.

"I wondered if you'd heard any feedback about how our patient in Mexico
was doing?" I hoped I sounded appropriately offhanded.

Forbes immediately frowned.

"You mean David Pearson?

To tell you the truth, I haven't heard anything at all." He leaned
forward, the lines of his face pushing into a scowl.

"He's not the Pearson the police are asking about, is he?"

I made my face into what I hoped he'd interpret as astonishment.

"The police aren't asking about David. Why would they? He's in
Mexico." But they soon could be, I thought.

Forbes said nothing, his expression neither skeptical nor believing.

"Yeah, you're right," he finally replied.

"It must be another Pearson."

"Is there anyone in particular at the clinic who could tell me--" "I
understand you found Saswald," he interrupted, "after he was... well,
you know."

"No, I was called to the scene with the res us team, but obviously it
was too late. Now about David--" "Is it true what I heard, that he'd
nearly been decapitated?"

His persistence about the murder started to annoy me. I'd come to
learn about David, hoping to hear that he was doing fabulously. I had
the notion that if he was in any shape to handle the news, I'd phone
him immediately, at the clinic, and tell him about what was coming his
way. I owed him that, and more. Even if he had nothing to do with any
of this, which was likely, Riley homing in on him would still be an
ordeal. I figured the least I could do, having launched the detective
at him, would be to give David time to prepare for the onslaught.

But first I needed to find out the man's state of mind.
If he was pretty shaky psychologically, I'd have to think of another
way to protect him, such as going down there if I had to.

"Look, Peter, the police told me not to discuss what I saw.

Now can you please tell me when you expect to know something about
David?" I hadn't intended to speak as sharply as I had, but I wanted
him off the topic ofSaswald.

For a second I thought I saw the slightest of frowns emboss Forbes's
brow, but I couldn't be sure--ever since I'd known him, he'd been a
hard read. Finally he shrugged and answered, "Matter of fact, I
wouldn't expect to hear anything about how David's doing. That clinic
he went to is involved with an experimental protocol, and they aren't
going to be too free with information about what they're doing until
they actually publish their results. I must say," he added, "Pearson's
prognosis isn't good, not at this stage. You no doubt are aware of how
addiction goes through a succession of plateaus...."

Oh, Christ, I thought, the last thing I wanted was to sit through one
of his usual long-winded dissertations, even if it was a description of
the latest line on alcoholism. Still, I figured that I better feign
interest in the old goat, in case I needed his help later. It sounded
as if the clinic was extraordinarily secretive, and as the referring
doctor, he might be the only one who could convince the place to make
an exception and release a report on David's progress.

"... been no advance in treatment of alcoholic addiction in over thirty
years ..."

As he droned on I found myself musing about whether David had sat in
this chair during therapeutic sessions, and what he'd thought of Forbes
as his treating physician. I'd seen enough of the psychiatrist's
clinical work in ER over the years to consider it reasonably competent.
The fact that he was so unassuming physically, as long as he had a
white coat over his four-thousand-dollar suits, made him nonthreatening
to his patients, and he had the least judgmental manner of anyone I'd
ever met.
"... still just a forty percent chance of staying dry..."

As a result he could make people feel completely comfortable about who
they were and what they'd done, sometimes even when they should have
been damned upset with themselves.

In fact, outside his performance in ER, I was always uncertain if in
the long run Forbes might be failing to adequately motivate his
patients to change for the better, simply teaching them to be
comfortable with their same screwed-up selves instead.

"... there may hopefully be better therapeutic options in the future.
So is there anything else that brings you to my den?" Peter asked,
whisking me back to the present.

The end of his soliloquy caught me by surprise.

"Have you heard anything in general about this clinic?" I asked,
scrambling to put together an intelligent question.

"I must say, I found it odd, an HMO like Brama sending a patient to a
special program, let alone all the way to Mexico."

"Ah, yes, I heard about your feud with Brama," he commented, without
revealing the slightest hint of how he felt about it, for or against.

"As I said before, I've been told nothing."

"Come on, Peter, even if they are doing a confidential study, doctors
blab about their work to other doctors. What's the gossip about the
place? Have you sent any other patients there?"

He stared at me a few seconds, again inscrutable, and I had no inkling
whether he minded me pressing him. He finally replied, "I've only had
one other patient go there, and he did very well--is still dry as far
as I know. Now if you'll excuse me--" "But what's the buzz on the
place, from your colleagues in other hospitals around here, or in other
cities? You must have had some feedback--" "Yes, I've heard favorable
comments from a few other psychiatrists around town who've sent
patients there," he cut in, his tone still completely matter-of-fact.

"Now you really must excuse--"
"You've no idea what their treatment program is? Did your other
patient mention at least if they were using new drugs as part of
their--" "I repeat, I've no idea, and to find out you'll have to wait
like the rest of us until Brama publishes what they're doing."

As he talked he reached over to retrieve the microphone on his
dictating machine and made a show of rustling his notes in front of
him.

"Sorry I couldn't help you more," he said, and smiled.

"Do you have their phone number?"

"No, I don't. Perhaps you could obtain it from the Brama offices here
in town."

Yeah, sure. I was such a popular guy there right now.

Funny, I thought, once I'd thanked him for his time and was out in the
hallway walking away from his office. A raft of questions like the
ones I'd just asked would normally have been enough to set the usually
loquacious Forbes spouting off for about an hour. Yet now, despite the
man's impeccably evenhanded manner, I was left with the distinct
impression that he was no more interested in talking about the clinic
than I'd been in dwelling on Saswald's murder. In fact, I felt as if
the psychiatrist had just given me the bum's rush.
Chapter 6

It was just before seven the next morning and I was stuck in traffic
under a knot of overpasses when I heard from Riley again.

"Morning, Doc. Guess what?" His excitement was audible even over the
raspy connection of my cellular.

I braced myself, thinking he'd already found out about David.

"I think you were right about there being something fishy with
Saswald's connection to that Brama addiction clinic. I went over to
their offices late yesterday and had a talk with the president of the
company himself."

"The president of Brama? You mean the local CEO, don't you?"

"Nope, I mean the president, a Mr. William Baines, all the way from
their head office in San Francisco. He arrived from there yesterday
morning for what he claimed was a preplanned visit."

"Really?"

"Yeah, really. Of course, he said he was shocked to learn of Dr.
Saswald's death when he arrived."

I was rapidly becoming intrigued.

"You sound as if you don't believe him."

"You ought to meet the man. He's a real power dresser-not the kind to
get his suit all wrinkled by a night in an airplane seat, albeit a
first-class one, unless he really had to."
"You think he flew out here because ofSaswald's murder?"

"If he didn't, it's another coincidence, isn't it, on top of the ones
you told me about" I felt a stab of apprehension.

"Look, I won't talk about that anymore--" "Doc, listen, there's more.
On the surface everything at Brama appeared as smooth as the sides of
that big glass building they're in, but a lot of little things bothered
me."

"Such as?"

"For starters, this guy Baines insisted he take my interview himself.
Up until then my officers had been dealing with a personnel manager and
a few other middle people who'd handled Saswald's previous freelance
work with the place. The highest they got was to the medical director
who'd recently hired Saswald full-time. Now this Baines guy arrives
off the redeye, obviously tired, and insists on dealing with me
personally.

Then there's another thing I found strange..."

Static took away his voice as I reached the ramp leading up to the
expressway overhead. Within seconds he faded back in.

"... asked if anyone named Pearson had anything to do with Saswald at
Brama. At that point Baines called in the CEO, and the two men made a
show of scratching their heads and promising to have secretaries check
their personnel records for anyone of that name and that they'd get
back to me.

Now, other officers had already brought up the name during earlier
interviews, so I'm sure these two were prepared..."

Creeping through the shadow of yet another overpass treated my ear to
more fuzz.

"... questions about the addiction clinic and Saswald put a little
wariness in their eyes, but Baines claimed an anesthetist would never
be required at a research facility for alcoholism."

"That's essentially what Saswald told me, and frankly, it's a
reasonable statement."

"Yeah, but then they wanted to know why I was asking about the
addiction clinic. I didn't mention your name-didn't have to; I'd
already checked and found a few others who'd been at the reception and
overheard your argument with him. So I simply stated we had witnesses
who'd seen Saswald get pretty exercised at being asked about the
place.

Baines and his CEO seemed to have a little trouble digesting that
surprise--they both looked as if they'd just seen a turd on the
rug--and when I demanded, "Do you have any idea why he'd be upset like
that?" they of course protested that they didn't. But I sensed that
I'd really put them off balance. And when I asked if they knew of a
patient named Pearson having anything to do with Saswald's freelance
work at any of their other clinics, Baines, instantly becoming ice,
told me very politely that any and all information involving patients
was confidential. His CEO clammed up as well."

As he should have, I thought, still furious at my own laxity
yesterday.

"So what's your problem with that?" I snapped, but immediately
regretted sounding so testy. I took a swallow and attempted a more
civil tone.

"In that regard, they acted appropriately."

Riley continued.

"The CEO's not as tough as his boss. By now that man's smile was as
frozen as a TV dinner, his eyes shifting anywhere but toward mine, and
his leg dancing a nervous little jig. So I put my best question of all
to him--if he knew specifically of an alcoholic patient at St. Paul's
named Pearson who'd had something to do with the addiction clinic in
Mexico."

Shit!

"Goddamn it, Riley. You may have thought you were clever yesterday,
but going public with what you inferred out of that inexcusable session
we had--" "They hit the roof too. Doc. Demanded to know who I'd been
talking to at St. Paul's, who'd been giving out confidential
information, who at Brama had breached security--the whole works. Then
I set them straight." His voice was suddenly hard.

"I informed them that nobody had told me anything inappropriately. I
advised them that we had a lead from the crime scene suggesting someone
named Pearson may be connected to the murder, and that in every phase
of this investigation we would be looking for a connection between
Dr.

Saswald, his places of work--both at St. Paul's and Brama-and
someone--staff, patient, or private individual--named Pearson. So get
used to it."

In the silence of another truck cutting us off, I felt he was trying to
set me straight as well.

"They also mentioned that I should take a closer look at you," I heard
him saying when the static cleared.

"Pardon?"

"Just as I was about to leave, the two of them put on another dog and
pony show, this time wringing their hands and professing their profound
reluctance to bring it up, but they wanted me to know that there was an
individual at St. Paul's who was extremely hostile to their
company."

"What?"

"I frankly think they'd rehearsed how they would make the revelation.
It was pretty slick. They didn't do anything as outlandish as suggest
you were the killer. They simply intimated that since I obviously
intended to leave no stone unturned, and since Saswald was connected to
Brama, I should be aware of someone who had an axe to grind, blah blah
blah-that kind of thing."

"But why do that? To what purpose?"

The silence on the line made me think I'd lost contact again, but a few
seconds later I heard him sigh, loudly and clearly.

"Why?" he repeated, after a few more seconds.

"Probably because you're making them nervous about something and they
want to discredit you. Didn't I read a few weeks back that you accused
them of committing no-fault murder?"

"Saswald's death has nothing to do with that."

"Well, maybe they see a murder investigation as an opportunity to throw
a little mud your way and undercut your effectiveness on other fronts.
I have to tell you, your comments back then hit a real sympathetic
nerve with everyone I know.

Brama's got to be a bit afraid of you..."
At that point the static welled up and persisted for half a minute.
When it subsided, the line was dead.

I finally reached the expressway and sped toward downtown Buffalo. In
my rearview mirror I could see the sun peeking over a line of clouds,
and in front of me the entire city became bathed in light for the first
time that week.

Mulling over Riley's conversation, I was struck by what he hadn't
mentioned. I didn't know if it was because he hadn't yet gotten his
warrants, or if he had and was keeping the result from me, but he
hadn't breathed a word about looking through the eighty-two charts in
the hospital vault and finding David's.

The uncertainty was doubly frustrating because at the moment I had no
idea how I was going to get a warning to David.

After leaving Forbes's office yesterday, I'd actually tried to inveigle
the clinic's number from Brama--several times.

"That's unlisted," I'd been told by a receptionist on my first try.

"Could I have your name, please?" another one had asked when I called
back later with the same question.

"I'm sorry, but you're not on our list of physicians with access to
that information."

I'd then even called their headquarters in San Francisco, and got the
same routine for my trouble. My last resort--an attempt in my high
school Spanish to reach the place through information in Tijuana--got
me connected to a liquor store.

Maybe his family had the clinic's number, I thought, despite the ban on
incoming calls. But if I came out of the blue at them, saying that I
had to contact David all of a sudden, I might get them worried and
precipitate questions that I couldn't answer.

Finally breaking free of traffic, I was able to get up enough speed to
do the expressway justice and shot along a stretch of road bounded on
both sides by the veterans' cemetery. Farther to the left was the
crumbling East Side, source of most penetrating injuries and drug
overdoses at St. Paul's. Away off to the right were the upscale
neighborhoods where the diseases of affluence abounded--heart attacks,
diabetes, colon cancer-but poverty and poor food produced their share
of these disorders on the opposite side of town as well. Other
maladies were nondiscriminatory--lung cancer, AIDS, alcoholism--and
frequented all parts of the urban landscape that sprawled in every
direction as I drove into its center.

By the time I reached the exit ramp for St. Paul's, I still had no
idea how to reach David, and my frustration was mounting.

"Get used to it," I muttered, taking the turn far faster than I should
have.

Her name was Maggie, and she'd arrived by ambulance late that
afternoon. I could have told her age by counting her wrinkles, ripples
of them forming pouches under her eyes extending into her cheeks.
Larger folds of skin dangled from under her chin, and great slabs of
veined flesh drooped down from her belly. She was having trouble
breathing as she leaned forward in the bed so I could listen to her
lungs. They mewed like a basket of kittens each time she exhaled, and
I thought I also heard the extra sound a failing heart makes as it
gallops to try and keep up with its workload. I gave her oxygen and
checked her medications--a mixture of pills, pumps, and patches. Some
were meant to open her stiffening lungs, others to drive her withered
heart to provide even more heroics, such as sustaining the effort it
took for her to walk across the room. But all were appropriate, and
there wasn't anything I could add to what was already prescribed.

"Can... you fix me up. Doc... so I can go home." Her rapid breathing
broke up her speech, and the sides of her cheeks flapped with the
laborious effort of moving air in and out.

"Oh, I think we can make you comfortable," I dissembled, then gave
orders to Susanne to give her pretty well the same drugs that she was
already on, but by mask and through IVs.
They'd be delivered at a slightly higher dose, which would help her
for now, as long as she stayed quiet. But as soon as she tried to
carry out the activities of daily living again, she'd once more be
unable to breathe. She needed care in a nursing home.

"It's home... I want. You've got to... get me home."

"But you live alone, Maggie," I countered, reading the nurse's
admission note.

She gave a toothless grin.

"That's 'cause... I can't... get a nice ... young man.... Wanna...
apply?"

"Sorry, I'm married."

"Nice ones... always are."

"Do you have any family?"

"Not here ... Son's in California... out of work."

"Maybe you shouldn't live alone anymore," I suggested gently.

"Rather die... than go... in a nursing home. House is... all... I
got."

"But you'd be better off--" "I've seen ... the dumps I ... would be
able ... to afford.. ..

Rather die."

Leave it for now, I decided.

"Well, you'll have to stay with us for a little while anyway, to get
you back in shape."

"Don't... want... that."

"But--" "My neighbor .. , two houses away ... had to pay .. . her own
hospital bill.... Thirty thousand... Lost her house."

"But you've got insurance."

"They don't... always pay."

I took her papers and faxed in the request for an admission.

Fifteen minutes later I had a response. Provisional approval, subject
to final authorization.

"Not... good enough... Doc," said my wary octogenarian.

I got their triage officer on the phone.

"What will you look at to approve final authorization?"

"A documented acute deterioration," he said matter-of factly
"Significant changes in blood gases, pulmonary function tests, and her
echocardiogram results since last admission." It sounded like he was
reading from a list.

I already knew that her readings weren't radically different.

"She's so fragile, even minor changes could tip her into severe
respiratory and cardiac failure," I protested, trying to introduce at
least a modicum of medical reality into the conversation.

But with these non doctors who prattled out their rulings, the effort
was invariably futile and always drove me to distraction.

"I remind you. Doctor," he said preachily, "that you have an
obligation to do what is right medically. Admit her if you feel it's
justified. I'm simply stating what our company will cover, and what it
will not."

"But she lives alone. She'll probably relapse if she returns there."

"Well, according to our records, she's refused to enter a suitable
geriatric facility. It would seem that's the problem, and as you know,
we don't authorize social admissions."

I felt my teeth start to clench.

"And what do you provide? For starters, could we get her into your
extended care program?"

"Admission to an extended care facility is only for approved patients
following their discharge from an acute care hospital," he intoned,
"and meant solely for those who will ultimately be capable of living on
their own."

"Any home care?"

"Sure, but again, exclusively to help resolve acute medical problems
following an approved admission."

I knew all this. Maybe it once even made sense, when admitting
patients in the first place wasn't such an ordeal.

"Tell me something: Are all these tough guidelines for admission that
you're imposing here something adopted recently?"

The line was silent a few seconds.

"I have nothing to say about that," he then told me, his voice suddenly
cold.

When I got off the phone, I explained, "We'll get you breathing better
in ER, maybe even keep you overnight, Maggie."

What I'd do with her after that I had no idea.
She grinned at me despite her distress.

"Told you ... they wouldn't... pay," she wheezed.

Worse, the company wasn't Brama, but a competing outfit that hadn't
usually given me this much difficulty. I was left with the suspicion
that they'd decided to see how much of the Brama-type tactics they
could get away with.

A few hours later I'd finished my shift and was headed toward my
office. It was located in a back corridor, ten seconds from ER if I
ran, but far enough away in people's minds that unless there was a
major crisis, they'd learned to leave me alone when I retreated there
to do paperwork.

Since there was no one around in this part of the hospital at night,
the cleaning staff practiced a strict lights-out policy-part of our new
austerity measures--and the only illumination came from the red exit
signs over the doors. But the glow was more than sufficient for me to
find my way since I knew the area like the back of my hand, and I never
bothered switching on the overhead lights for the thirty-foot walk to
my door.

I was fitting my key into the lock when I heard a man's voice speak my
name from the near blackness at the end of the corridor.

"Dr. Garnet?"

I whirled and saw his shape rise up from a bench where he'd been
sitting in the shadows. But the pleasant tone of his voice left me
more startled than afraid.

"Yes?" I said, watching him come toward me.

"What do you want?"

He emerged from the dark into an area of ambient red under one of the
exit signs, and at once I could see he was a patient, dressed in our
standard-issue white robe over a green "Johnny-shirt."

"You shouldn't be here," I told him sternly, assuming he'd come from
ERIt's okay. Doctor. I'm going home in a few days and I'm allowed out
of my room." He pulled his left hand out of his robe pocket and held
it out to me. The sleeve rose above his wrist, and I could see the
identification bracelet. He was from one of the floors upstairs.

"Well, you still shouldn't be in this area," I admonished, less
harshly. I figured he must have wandered through Emergency, and no one
had noticed him slip in here.

"Now if you'll simply go back out that door--" "But Doctor, I've been
sitting here an hour to see you.

You looked so busy out there, I decided to wait until you were finished
rather than disturb you. This will just take a moment."

Even in the thin light I could see enough of his features to think he
looked vaguely familiar. He was young--late twenties or early
thirties--had close-cropped dark hair, a slightly pudgy face, and an
intense wide-eyed look that made him seem almost childlike despite his
large shoulders and stocky build. I must have taken care of him at one
time, I thought, presuming he'd probably been admitted by my
department.

Despite his being where he shouldn't, I decided to be gracious.

I figured he was there either to complain about how we'd treated him or
to thank us for it, and whichever it was, giving him a stiff reprimand
wouldn't help our public relations any. I finished unlocking my door,
clicked the lights on inside, and turned to invite him into my office,
intending to hear him out in as short a time as possible.

He removed his right hand from the robe pocket, his fist wrapped around
something as he held it out to me. At first I thought it was a pen--a
few inches long and dark--until its end caught the light streaming out
from behind me. Even as the steel flashed in front of my eyes I
couldn't believe what I was looking at. He had a scalpel.

"Oh, my God!" I heard myself say, backing away from him. It took me a
heartbeat before I thought of slamming the door between us and locking
myself in, but when I tried, he'd already entered the room enough to
block the move with his body.

"Help!" I screamed, continuing to back away.

"Help me!
Susanne! Someone! Help!" He stepped the rest of the way in and
closed the door behind him, cutting off any chance I'd be heard as far
away as our busy and noisy ER.

Reflexively I held up my hands, palms out in front of me.

Even as I did so I knew it was a futile gesture, the times I'd seen
defensive knife wounds on the hands of stabbing victims racing unbidden
to mind. And what he was holding could shred flesh better than any
knife.

"Who are you?" I demanded, backing up the few feet that remained
before I pressed against the front of my desk. My voice had easily
betrayed my rising panic.

He said nothing, but stayed where he was, moving his free hand behind
him and snapping the lock shut. He gazed steadily at me with his wide
innocent stare.

"I am the power; you are the Satan!" he suddenly roared.

I tried to steady myself while the rules I'd used in twenty years of
encountering violent patients flipped wildly through my thoughts.
Assert control, be firm, but don't challenge.

"Tell me why you're doing this." To my own ear I sounded as if I was
begging.

He remained at the door, the scalpel held out toward me.

Was he about to charge, slashing as he came? I slowly flexed my legs,
preparing to spring backward and roll across the top of my desk. If I
got it between us, hopefully I'd have the nick of time I needed to
dodge his first rush at me. But what then?

He stood motionless, simply continuing to look at me. I kept watching
the scalpel blade and his expression, trying to anticipate his next
move. Managing violent psychotics over the years had taught me another
rule, one that wasn 't in any of the textbooks: watch their eyes. Some
had pupils that were wide, black, and alight with rage or terror--the
result of massive adrenaline overload unique to some forms of
psychoses.

They were often the ones possessed by superhuman strength;

only a dozen orderlies plus a syringeful ofhaloperidol could fell them.
But the man in front of me had flat staring eyes, as lifeless as a
shark's and as empty as the voids of space. His was probably a more
methodical madness, the kind that could make him shove an unsuspecting
stranger off a subway platform in front of an oncoming train, then let
him calmly explain that voices told him to do it.

"I am the power; you are the Satan!" he repeated loudly, taking a step
toward me.

I rolled back over my desktop, came up on my feet and grabbed for my
phone. I had the receiver in my left hand and was reaching with my
right to punch 0 when he sliced the back of my index finger with a
swing of his scalpel.

"You fuck!" I screamed, more with horror than pain. I jerked away
from him, dropping the phone and quickly squeezing the cut digit
tightly in my good hand. Blood welled out between the encircling
fingers and ran down both my forearms.

But my attention was on him as he stepped around behind the desk to
where I was standing and raised his scalpel for another swipe. This
time he was holding it at the level of my eyes, his expression all the
while remaining as indifferent as if he were about to offer me a
haircut.

He had to be schizophrenic, I thought, desperately scrambling for some
idea of how I could stop him. Most likely I'd treated him previously
for relapses in ER. And his madness involved some sort of religious
delusion.

He started to arc the scalpel toward my face. I ducked and rolled to
my right. His arm swung over me, but when I came up on my knees, I saw
him rotate his wrist and bring the blade at my head with a backhand
stroke. I was now partly around one end of the desk, crouched between
him and the door. All I could do was scurry away from him in a reverse
crab walk while he kept up his advance, continuing to make downward
swipes back and forth at my face and trunk, turning his scalpel into a
pendulum.

"Get away! Get back!" I bellowed.

The tip sliced through the left lapel of my lab coat, missing my
underlying skin. But coming back, he got me lower down on the same
side, at my abdomen. I didn't feel any pain and thought he'd missed
me again when a thin red line half a foot long appeared through the rip
on the white cloth, then started to widen.

"Christ!" I screamed, frantically trying to scuttle backward even
faster, reflexively slapping my good hand over the spreading blood
while teetering on my right.

My thoughts raced. I knew once I reached the door he'd be all over me
and I'd be dead. I'd never have time to get to my feet, turn the lock,
and escape. I had to try something, anything that would break off his
steady attempt to further slash me to ribbons. The red stain was
growing beneath my fingers.

I thudded into wood at my back. Out of chances, I grabbed a deep
breath and opted for something that was very definitely against the
rules of psychiatry.

"I am of the son of God, and the power over your voices is mine!" I
roared, making the sign of the cross at him. If I couldn't stop this
madman, perhaps I could turn his demons against him.

"They are the Satan!"

He didn't even flinch as he stepped up to straddle my legs and raised
the scalpel over his head.

Oh, Christ! I thought, and yelled even louder.

"Stop! You know I command the voices. You know I take them away.

You know I've done it before! You're here now so I can take them away
again. Obey me, in the name of God!"

He simply looked down at me.

"The voices of Satan are telling you to kill me, because they know I
can destroy them with the medicine I give you.

You must fight their evil with me. It's my voice which must command
you now!"

For an instant he seemed to waver. His expression didn't change--it
remained indifferent as ever--but he stood with his head cocked to one
side, his weapon in the air, as if he was listening for something. His
voices? Were they going to counter my bid for control of his mind?

I lay at his feet, not daring to move, not even to breathe.

Seconds went by--I knew because I could feel my own heartbeat keeping
time. Despite pressure from my hand, the blood kept seeping through
my lab coat until the line was wider than my outstretched palm. I
could also feel it trickling around my sides and into the small of my
back. I still didn't notice any pain. All I focused on was the tip of
the scalpel poised above me, watching for the slightest hint that it
was starting down.

He began to mumble.

At first I couldn't make it out. The sounds weren't words, but
gibberish, accompanied by nodding and pauses. He was talking to his
demons. God forbid they were repeating my death sentence.

Then, without warning, he said, "Dr. Garnet, the voices you control
didn't tell me to do this. That was a new voice. It's not here now,
so you can't control it." The quietness of his speech made it seem to
come from a great distance, as if his own voice was disembodied from
him. It gave me the chills, but also put me on my guard. As he spoke
I managed to slowly bend my right knee, and I was ready for him when he
swung the scalpel at my face. I ducked my head to one side and
delivered a vicious kick deep into his groin.

He let out a screech and, already leaning forward to reach me with the
scalpel, doubled up enough that the force of the blow propelled him
headfirst into the door behind me. His aborted swing buried the blade
harmlessly into the wood beside my left ear, where it made a loud
crunch.

He stayed arched over, groaning and gasping for breath.

Before he could recover, I flexed both my legs, planted the soles of my
shoes against his stomach, and heaved him off me as hard as I could. He
staggered backward the length of my office and crashed into my desk,
where he slumped down to join me on the floor.

I was first to my feet, blood running down my legs despite the pressure
I was applying to where he'd cut me. Gingerly I moved my left hand and
lifted the blood-soaked flap of my lab coat. Then, using the third
finger and thumb of my right hand, I managed to get enough buttons
undone on my shirt to grab a peek at the damage. Despite its length
and the mess, I could see the laceration was only partially through the
thickness of the skin. Reassured that I wasn't about to have my
intestines fall into my hands, I reapplied pressure on my side and,
despite a palm slippery from the previous cut to my index finger,
managed to get the door open. Stumbling into the hallway, I glanced
back to see if he was coming after me, but he was still doubled over on
the floor and trying to recover his breath. Nevertheless, there
appeared a spark in his eyes as he glared up at me, and they began to
glow with a dark fury that hadn't been there before. It was time for a
dozen orderlies and a syringe. I reached back around the door,
retrieved the scalpel with a yank, then raced toward emergency.
Chapter 7

My arrival produced bedlam. Patients and visitors screamed at the
sight of me dripping blood and running through the corridors while
carrying the scalpel. Nurses and residents ran up and offered their
help.

"My God!"

"What happened?"

"Get him a stretcher and lie him down."

A circle of helping hands tried hustling me toward one of the treatment
rooms.

I ignored them all.

"Every orderly in the place, get to my office. There's a violent psych
patient there," I bellowed.

"And I want a dozen more called on the PA." Three men in white
immediately spun around and dashed in the direction from where I'd
come.

"Be careful," I called after them.

"Just keep him cornered until your reinforcements arrive." I eyed
Susanne running to me, alarm all over her face.

"We need enough haloperidol to stop a horse," I told her.

"Get ten milligrams in a syringe, and as soon as someone has a clear
shot, give him the works. Plus you'll need posy belts and leather
ankle restraints on this one as well--" "Dr. Garnet! We know what to
do, now lie the hell down!"

she barked at me, taking me by the elbow and propelling me to the
nearest stretcher. More than a few eyebrows headed for the ceiling,
including my own, at her unprecedented sharp tone with me.
"Yes ma'am!" I said, submitting to her authority. 88 She then gave a
flurry of her own orders, sending anyone who was still standing around
scrambling to do their tasks, and a whole bunch of things began
happening at once. The call for help went out over the PA. Seconds
later more orderlies flew through the corridor on the way to my office.
Two nurses, one carrying restraints and leather cuffs, the other a
large syringe, quickly followed. Within minutes I was lying in a
treatment room, my wounds cleaned and prepped, and a pair of nervous
residents, one on either side of me, were starting to sew up my
lacerations. As they worked I heard them wheel my assailant into
another cubicle. Hospital regulations required that someone check him
over to make sure I hadn't hurt him.

"He has the power over my voices!" he was screaming.

"The power over my voices!"

By the time I'd gotten fifteen stitches in my side and four in my index
finger, including one in a partially severed extensor tendon, his
shouting still hadn't stopped. That was unusually long for the
haloperidol we'd given him to act.

After the dressing to my abdomen was secure, and Susanne had wrapped
enough gauze around the finger to make it look like a stumpy white
sausage, I exchanged my bloody clothing for a set of OR greens and
joined the residents taking care of my attacker.

As soon as I stepped into the room and saw him struggling against his
shackles--screaming, white-faced and sweaty--I felt a stab of alarm
that perhaps something else was wrong with the guy besides his
schizophrenia.

"What do we know about him?" I demanded, addressing the half-dozen
residents gathered around his bed.

A young woman whom I recognized from a rotation she'd done with us a
few months earlier handed me his chart from Psychiatry and explained
that he'd been her patient upstairs.

"His name is Martin Whitehead, he's thirty-three, schizophrenic, does
well if he takes his meds, but over the last ten years has been
subject to repeated relapses and admissions to hospital for going off
them. A week ago he was admitted in his usual agitated state,
screaming religious references..."

I let her voice become a drone in the background as I flipped through
his chart. Quickly I ascertained he had no other medical history,
particularly diabetes, and wasn't taking any medication in addition to
his anti psychotics Neither was he allergic to anything, nor did he
have a history of alcohol or drug abuse. In other words, apart from
his madness he was in perfect health.

"... was kept restrained until he began responding to being medicated
again..."

I nipped over to the section of his chart covering his many ER visits
and confirmed that I'd been the one to treat him on several occasions,
though not recently. On none of these did he demonstrate the violence
I'd seen tonight.

"... had begun to come around, and was allowed out of the locked ward
to participate with floor activities..."

I put down the chart, leaned against the wall, and crossed my
arms--wincing when the movement aggravated my fresh stitches. Meanwhile
the resident piled layer upon layer of facts about the man, which meant
she hadn't a clue why he wasn't responding to haloperidol as expected.
I looked again at his sweaty pale face and felt something familiar
suggest itself.

Something basic and routine toER when a patient arrives out of his
head, confused, or comatose, and we have no history to help us. I
stepped over to the side of his bed and felt his skin. It was cold. He
didn't even seem to see me as his eyes darted about the room and his
head thrashed from side to side. His screams and mumblings were
incomprehensible.

"Did anyone here do the DONT?" I demanded, interrupting the resident's
interminable recitation, which was going nowhere.

Five jaws dropped as her young colleagues betrayed their bewilderment
at what I meant.

"Did we do the what?" the psych resident said.
"The DONT. Remember? You learned about it while doing your rotation
with us. Dextrose. Oxygen. Narcan. Thiamine."

DONT was an acronym for the initial treatment automatically given to
patients presented with decreased mentation and with no one
accompanying them to tell us what had happened.

The routine addressed the most common causes for such a state--dextrose
would correct hypoglycemia, or low blood sugar; oxygen would help
reverse hypoxemia, whatever the cause; Narcan was the antidote to a
narcotic overdose;

and thiamine was the vitamin most likely to be deficient in alcoholics
with a persistent confusional disorder called Wernicke's.

"But Dr. Garnet, he's already admitted..."

"Not on diabetic meds..."

"No drugs or alcohol..."

"What he is, people, is a patient in ER with an altered mental status,
the cause of which we can't explain. And from the look of him--pale,
sweaty, and on exam, cool to the touch--even if he isn't supposed to be
taking pills that would make him hypoglycemic, I'm checking his sugar."
I'd already stepped over to a nearby equipment tray and taken out a
small glucometer.

Using a lancet, I pricked the tip of Martin Whitehead's finger-he
didn't seem to notice--and got a drop of blood for the test strip.
Sixty seconds later I had my answer.

"His sugar is two," I told my astonished onlookers. They knew the
implications of the reading without my explaining further. It was a
dangerously low level which could cause confusion, extremely aggressive
behavior, and ultimately seizures. In a paranoid schizophrenic who was
only partly controlled with his proper medication, the resulting
behavior--as we'd just seen--could be explosive.

They stood around in stunned silence while I riffled through drawers
under the counter until I found a resuscitation tray. I took out a
large pre prepared 50cc syringe of concentrated glucose, removed the
protective cap, and injected all of it into the side portal of the IV
line Susanne had started on him when he'd been wheeled in.

The results were almost immediate. The agitated movements ceased, his
incomprehensible yelling stopped, and his sweaty pallor pinked up to
more normal-looking skin. The sudden quiet in the room was eerie as
the young man stared at each of us, his gaze suddenly focused, yet his
expression uncomprehending.

"What happened?" he finally asked in a quiet, shaky voice.

Several times a day, day in, day out, the alarm is sounded at St.
Paul's to respond to an agitated patient. Most involve people in
Psychiatry, but a ruckus can occur anywhere. Most are minor, though
the possibility of someone getting hurt is always there. But there's
also the occasional, extreme case, when a patient heaves a metal fire
extinguisher at a staff person's head, for example, or suddenly grabs
them by the neck or flails at them with punches. Sometimes it's only
by luck or chance that the intended victim isn't seriously hurt or
killed. Martin Whitehead's eruption, on paper, seemed to be no
different from other relatively rare cases of extreme violence
involving patients.

There would be a case review checking how a medication mix-up could
have occurred. I'd already spoken with the man's nurses upstairs and
found that there were two diabetics on the floor who were taking oral
hypoglycemics. It wasn't inconceivable that in putting each patient's
pills into a dispenser cup, Whitehead had mistakenly received a drug
that would make his glucose level plummet. Whatever had happened, by
the time Martin Whitehead had been wheeled back to Psychiatry along
with his chart he was considerably calmer, though continuing to babble
the stuff of delusional thinking steeped in religious symbols.

Yet as I sat in the nursing station filling out my portion of the
incident report, I remained troubled. At first I thought my unease was
because I'd never come so close to being killed by a patient before,
and I simply tried to shake it off.

But other thoughts kept plaguing me as I wrote up what had happened.
Most attacks on staff members that I'd seen seemed to explode randomly
out of routine pieces of business by the caregivers--their checking
vitals, drawing bloods, or doing a physical examination. Even such a
little thing as ordering a patient back to bed could send him or her
into a rage, but the event usually occurred on the spot. In this case,
Whitehead had come looking for me, years after any encounter I'd ever
had with him in ER, and had somehow found a scalpel on the way. That
suggested a degree of intent that didn't jibe with an isolated
psychotic breakdown fueled by hypoglycemia. Yet I'd seen the blood
result and treated the man myself. There was no question of the
authenticity of what he'd had.

I shuddered, then told myself that the thought of a psychotic patient
specifically targeting me after such a delay was absurd. Shoving the
notion out of my mind, I concentrated instead on getting my report done
so I could go home.

The trouble was, I found it difficult to write, having to wedge the pen
against my bandaged finger with my thumb.

The sutures would come out in ten days, but the tendon would take three
weeks to heal completely. In ER my ability to use a pen and scribble
fast notes was nearly as crucial as being able to use a stethoscope,
and the handicap was going to be a pain.

"Damn!" I muttered, rereading my account of what had happened and
seeing how indecipherable it was. At one point I'd slurred the letters
so badly that it looked like I'd said Whitehead had slashed my throat
instead of my coat. I was correcting the error when I thought of
something that perhaps I should have questioned much earlier.

"Oh, my God!" I said out loud.

"What's the matter?" Susanne asked as she passed behind me on her way
to meet a new patient.

"Oh, nothing," I dissembled.

"Just that my writing isn't readable anymore."
She grinned at me over her shoulder.

"What do you mean anymore^ It never was, Chief."

I tried to smile back but my heart wasn't in it. An icy chill was
encircling my chest as I wondered if a medication error had
accidentally put Martin Whitehead into a similar state once before. And
he had ended up cutting Hector Saswald's throat.
Chapter 8

The crowd of visitors at the elevator--all festooned with offerings of
flowers and fruit baskets and appearing to be about the size of a block
party--was unusually heavy for a Wednesday night. I took the stairs
instead, two at a time until the stitches in my front yanked me back to
a slower pace.

"Whitehead was admitted to a locked ward last week," the resident had
said. Saswald had been killed two nights ago.

The obvious question--had Whitehead still been under lock and key at
the time of the murder--I'd only be able to answer after looking at his
chart and talking to the nurses who'd been caring for him.

The first person I saw when I rushed into Psychiatry's nursing station
was Peter Forbes. For once I could tell from his expression what he
was feeling. He was flushed all the way from his shirt collar to his
bald spot, and his frown this time was no faint affair, having pushed
his forehead into more ridges than were usually on a snow tire. The
object of his displeasure was in his hand--the familiar form of an ER
resuscitation record filled in by Susanne's neat handwriting and
clipped to the front of Whitehead's chart. Forbes looked up from
reading it when he sensed me watching him. His high color went a shade
darker.

"What are you doing here?"

he demanded.

"And I don't appreciate the way you people in ERinsinuated my
department was responsible for a medication error ""Easy, Peter," I
admonished.

"We're not accusing anyone of anything."

"Oh yeah! Your call to my nurses and the questions you asked about
other diabetics being on the ward as much as blamed them for a mixup--"
"I suggest you focus on what's happened, not who's to blame. I take it
Whitehead's under you." As this month's admitting officer for
psychiatric emergencies, he'd be supervising the resident I met
downstairs.

His eyes flashed at my cutting him off.

"What did Whitehead say to you that makes you so sure he was given
something?

Your glucose reading could have been wrong."

"He said that he was the power and I was the Satan. Come on, Peter,
what do you think he said? He's your patient and we all know he's
psychotic. But there was absolutely no mistake in his reading. All
the clinical signs of hypoglycemia were there to back it up, and his
abrupt response to dextrose was clear-cut."

Our hostile exchange was attracting the attention of the nurses working
nearby. I stepped closer to Forbes and lowered my voice.

"I strongly suggest we take this to your office.

We may have a hell of a lot bigger problem than what happened
tonight."

His red face began to blanch at chameleon speed.

"What do you mean 'bigger problem'?"

"Your office," I insisted.

"And bring Whitehead's chart."

Behind his closed door the mood between us didn't improve any. He
didn't even offer me one of his fancy chairs and remained standing
himself, across his desk from me, the furrows in his forehead
undiminished.

"Well, what's this more serious problem?"

I knew what I was about to suggest wasn't going to help his
churlishness any, but there was no way to dress it up for him.

"Was Whitehead still under high-risk security the night Saswald was
murdered?"
The impact of my question on Forbes was as if I'd given him a jolt
from our resuscitation paddles in ER.

"You're not serious?" he exclaimed, his color completing its
transformation to pale.

"Why that's... impossible!"

"Not unless you can guarantee that on the night of the murder he was on
this ward between the time Saswald was last seen alive and nine p.m."
when they found him."

"My God, the very idea's unbelievable...." His voice trailed off as he
seemed to collapse into his chair.

Visions of Whitehead's steadfast attack on me danced readily to mind,
reinforcing that it was all too believable.

"The record?" I pressed, tapping Whitehead's chart, my impatience
clearly evident.

"Of course," Forbes said, as if snapping out of a trance, all trace of
our quarrel gone from his voice. It was strange. I wasn't used to
seeing the man so transparent about his feelings, but I could have
sworn I saw his expression shift ever so slightly from disbelief to
just a hint of relief. He quickly nipped open the chart and found the
pertinent notes for the night in question. He scanned several pages of
handwritten entries by nurses, each with dates and times, then, in
another section, more notes on blue-colored paper, which I knew would
be the resident's clinical observations. As he read I saw his frown
return, and I expected the worst. But to my surprise, he looked up and
pronounced, "No, you're wrong. He was still in the locked section for
unstable newcomers. He was never out of our sight that evening. Here,
see for yourself," he said, shoving the chart at me.

I skimmed through the same pages he had, using my bandaged finger to
guide the way. There was no doubt about it. Martin Whitehead had
never left the premises that whole day, let alone during the fatal hour
in which Saswald had his throat cut.

I found myself exhaling a sigh of relief as I closed the file, for
Martin Whitehead's sake. As awful as what had happened tonight was, it
wouldn't be a police matter. Soon antipsychotic drugs would beat his
voices back into submission enough that he'd once again be released
into the streets, and he'd return to whatever life he was able to keep
a grip on out there.

Until the next time.

Hardly a scenario to celebrate, I mused, but it was the best he could
expect to have. In my business, that sometimes had to be enough.

"Well, good for Martin Whitehead," I said, getting ready to leave. I
certainly didn't want to hang around Forbes any longer, in case he got
riled up at me again for having suggested the medication error.

But he didn't reply, just sat behind his desk staring off over my
shoulder at some point on the wall behind me, a worried look on his
face.

Weird, I thought, turning for the door. It was probably a good thing
that he normally didn't show his emotions. When he did, they were
confusing as hell.

"Right," I heard him say as I left the room, his voice sounding vague
and far off.

"Good for Martin Whitehead."

On my way out of the department the nurses slid me a slew of dirty
looks as I passed their station. I was thinking that my provisional
diagnosis about their role in the night's meltdown hadn't made me any
friends among them either, when up ahead the doors to the ward flew
open. A portly middle-aged man hurried in, followed by a sum woman who
seemed slightly younger. Even from that distance I could see the worry
on their faces, and the man's features had a familiar wide-eyed
innocence about them that made me catch my breath. The two raced by me
and went directly to one of the nurses.

"Excuse me," I heard the woman say, her voice shaking and breathless.

"We were called to come right away to the hospital. What's happened to
our son?"

I wanted to hurry out of there--my fatigue was settling into muscles I
didn't know I had, and my cuts were finally starting to hurt--but the
thought of them having to endure Forbes in his current distracted
state, whatever the hell its cause, made me hesitate. Perhaps I would
still have kept going if at that moment I hadn't heard the nurse's
reply.
"Mr. and Mrs. Whitehead, I presume," she answered, sounding
displeased, as if the distraught couple's not properly identifying
themselves had put her out somehow. She then said nothing, while their
expressions made it obvious they were imagining the worst.

"Well, you'll just have to wait for Dr.

Forbes about that matter," she snippily huffed after an interminable
few seconds.

I wheeled around.

"Martin's fine," was all I said, wanting to immediately let the parents
out of their agony, but my eyes were fixed on that abominable nurse. Be
angry at me if you must, I felt like screaming, but don't take it out
on them. I kept her in my glare until she turned away and flounced
off.

Then I strode over to where the victims of her torment were standing,
introduced myself, and explained as gently as I could what had
occurred.

When I finally got home, Janet insisted on inspecting the needlework on
my wounds after I'd told her of the night's events.

"I thought the idea was that you teach the residents, not let them
practice on you," she commented dryly, replacing the bandages after
giving the sutures a critical once over and pronouncing them "okay."

About how close I'd come to getting killed, she said nothing, yet I
knew it was bothering her terribly. That night I repeatedly woke up to
find myself held tightly in her arms as she slept, and reflexively she
clasped me even closer if I tried to move. When I held still, I could
feel her hold on me relax but not let go. Despite the laceration in my
front smarting under the pressure of her grasp, I fell back to sleep
each time, feeling blessed by the love of the fierce woman at my
side.

"Get another blood gas!" I ordered, quickly placing my stethoscope at
the bases of both his lungs. The air entry was good. One of the
residents grabbed a syringe and removed a few cc's from an arterial
line.
It was noon the next day, and I'd just intubated a fifty-two year-old
man who'd been brought in comatose after rising from a chair in a
restaurant, clutching at his head, and collapsing.

He was being ventilated, IV lines were in place, an arterial line was
inserted to provide samples for blood gases, and his bladder was
draining through a catheter inserted up his penis. He was also wired
to every monitor in the room, and whatever signs of life he had left in
him were showing grossly abnormal on the machines that beeped and
blinked at his bedside.

"BP's two ten over one twenty," Susanne said, bending over his right
arm and letting the air out of a pressure cuff.

The data was also on the monitors, but all of us had been burned with
bad numbers for vitals enough times that we still measured them the
old-fashioned way.

A resident at my side was shining a penlight into the man's pupils.

"Neuro signs are unchanged. Eyes deviated up and to the left..."

She was telling me that the motor nerves controlling his ocular
movements to the right were gone and that the unopposed muscles
opposite them, still intact, were pulling his gaze away from the
paralyzed side. By the dictates ofneuroanatomy, the brain damage
causing this particular phenomenon occurred in the motor cortex of his
left hemisphere. To keep things simple for the residents, and
ourselves, we teach that these kinds of strokes leave their victims
"looking at their lesions."

"... decorticate posturing; increased reflexes; up going toes, mostly
on the right."

Deprived of the upper brain, limbs then curl into flexed positions,
muscles jerk wildly when we tap reflex sites, and stroking the soles of
the feet raises the big toe toward the head on the affected side.

Snapping off her light she concluded, "Left pupil's dilated and
sluggish."

Pressure from the bleed had incapacitated his nerve for constricting
the iris on that side.
"What's the coma scale?" I asked her.

"No improvement there either. Still only a three."

The number was a measure of the patient's level of responsiveness

A three meant that he wasn't reacting at all to any stimuli--not to
words, not to touch, nor to pain--and was the lowest number awarded. A
common joke among the residents was, "Even a corpse would score three,
just for being there."

"Again, vitals?" I said to Susanne.

This time she read the numbers off the monitor--they must have jibed
with her previous manual check.

"Two fifteen over one twenty and rising--pulse forty-six."

A slowing pulse and increasing hypertension--further signs of a buildup
in pressure within the skull.

I turned to the woman with the penlight.

"Okay, what's your diagnosis?"

"Left-sided intracranial bleed, likely from an aneurysm or an arterial
venous malformation."

"Very good. And what's your treatment plan?"

"Neurosurgery stat.. ."

"Already called," Susanne piped up.

"They'll be here in minutes."

"... and for this instant, to slow the bleed, IV beta-blockers will
lower the pressure, and hyperventilating him will lower blood COz,
causing arterial constriction..."

In snippets like these we pulled together the man's clinical findings
and scored what his nervous system could still accomplish, all
according to the convention used in most ERs to establish the
diagnosis, the status, and probable fate of stroke victims.

"Good work. Doctor," I complimented when she finished and the nurses
had started to carry out her orders.

"You'll be a bright star in the firmament of your chosen career." She'd
used me as a reference in her application for a residency in
neurosurgery.
Her ebony skin creased at the corner of her eyes, her mask hiding the
rest of the smile. Then she was all business again.

"They'll probably want to go directly to the OR...."

Soon the neurosurgeon arrived with his residents, and immediately
huddled with the radiologist to arrange angiography-dye in the vessels
to visualize on X ray the location and size of the bleed--before taking
him to the OR to evacuate the blood and stop the bleeding. When they
were ready to shoot the films, we all made final checks of our
equipment, then hustled out into the corridor so as to avoid exposure
to radiation.

To my surprise, I was ambushed by Riley as soon as I stepped through
the door.

The scowl on his face and repetitive pulsing along his jawline
forewarned that he was upset.

"I need to speak with you!" he ordered.

My first thought was that he'd finally gotten his hands on David's
chart and discovered what I'd been keeping from him.

"Jesus, Riley, not now!" I protested, gesturing with my gloved hands
toward my patient. I then turned my back on the detective, hoping he'd
go away, and watched instead the technicians and radiologist as they
worked to get the shots we'd need. Images of the dye coursing through
the man's arteries appeared on a monitor located behind a lead-shielded
barrier.

The radiologist peered at it, trying to pinpoint the leak. He kept
asking for other views, and altogether the process was taking too long
for us to be away from the patient's side, even with all the
monitors.

"When can we talk?" Riley demanded, standing at my shoulder.

I couldn't hide my impatience.

"When this guy dies, or we get him to Surgery," I snapped, not taking
my eyes off the scene of total life-support that flashed, beeped, and
hissed in front of me. I was particularly worried about the man's
breathing as I watched and listened to his ventilator. It was meant to
assist his still-present respirations--I'd done the final adjustments
on the machine myself and set the alarms--but managing an airway in ER
required being at the patient's head.
"Get me a lead apron," I said to Susanne, "I'm going back in there."

"I've got it. Dr. Garnet," one of our more aggressive residents
volunteered as he grabbed the heavy body vest before Susanne could hand
it to me. He pulled it on as he rushed back to the head of the
stretcher. I saw that he glanced at the readouts for oxygen
saturation, made the appropriate checks of all the tubing, and
immediately listened to the bases of the man's lungs.

"Good air entry," he called out, "and the Oz sat, is ninety-eight."

I relaxed a notch. The young man seemed to know what to do, and for
the moment the patient's oxygen level was fine.

"It's important. Doc," Riley continued, whispering near my ear.

"I heard about what happened to you last night. The gossip's all over
the hospital."

"I'm okay, if that's what you want to know--" "Doc, doesn't the pattern
strike you?"

"What pattern?"

"Look at it. You questioned Saswald about a clinic owned by Brama. He
got upset about it, and less than an hour later he was murdered."

I felt a flash of annoyance.

"Look, Detective, I really don't have time to revisit that--" "Two days
ago I asked questions about that same clinic, and also got a very
annoyed response, this time from the good people of Brama. Yesterday
you were attacked with a scalpel."

"What?" I exclaimed, spinning around to face him.

"You can't be suggesting the two events were connected!" The
abruptness of my reaction got the attention of everyone nearby.

Riley glanced uncomfortably at all the raised eyebrows staring at us
over the top of surgical masks.

"Step over here a moment," he ordered, moving far enough away from the
group that we could resume whispering and remain out of earshot,
despite everyone now straining to overhear what had gotten me so
excited.

"Cops look for patterns in crimes, Doc," he resumed, "just, I suppose,
like you look for symptoms or signs of a given illness when you make a
diagnosis. I think we have to consider there might be a link between
the murder and the attack on you."

"But last night's incident was the result of a medication error! I
treated the patient myself."

"Maybe it was," he frowned, "or perhaps questions about that clinic are
stirring up a very dangerous pot. Is there any way the error and the
attack on you could have been part of a setup?"

I felt myself want to scoff at such a bizarre notion. It was so
crystal clear what had happened. A mix-up in pills was all, something
not unheard of in a hospital. I felt my stomach knot just thinking of
our own recent close call with a potentially lethal dose of IV
potassium. And medically it had made sense--accidental hypoglycemia in
a psychotic patient already bombarded by voices. The explanations had
been at hand. Yet Riley's question hit a nerve.

His frown deepened as he studied my silence.

"Can I know what you're thinking, Doc?"

Instinctively I balked at telling him what had struck me as odd about
the attack--the peculiar degree of intent in Whitehead's seeking me out
and bringing along a scalpel--because it was beyond belief that anyone
could have made him do what he did to me. He'd obviously been driven
by his voices at that time, so bombarded by them, in fact--he'd
referred to several, which was usual in schizophrenics--that he'd
seemed too unpredictable to have been made to carry out any action, at
least not reliably. I flashed back to my own futile attempt to
overrule the hold his auditory hallucinations had on him as I lay at
his feet watching the blade glint in the overhead light.

The recollection made me shudder, but I remained determined not to risk
setting the police on Martin Whitehead the way I had with David by
revealing too much, no matter how frightening or unusual I found the
incident.

"Offhand I'd have to say there's no way that patient could have been
sent after me," I told the waiting detective in a whisper, not wanting
anyone to overhear even my denying such a surreal idea, in case they
might feed it to the ruitior mill.

Riley scowled his dissatisfaction at my answer.

"Look," I quickly added, "I don't see how anyone could have controlled
him enough to make him do anything."

Over where the nurses and residents were shuffling restlessly at the
door to the resuscitation room, someone murmured, "At last," and a few
others started adjusting their masks. I figured that the technicians
must have nearly completed taking X rays and we were about to go back
in.

Riley also glanced in that direction, then quickly asked, "Will you at
least think some more about how it could be done?"

"Yeah, but don't count on much." I turned and walked over to rejoin
the others, molding the top of my own mask around my nose, to keep my
breath from escaping upward and fogging my glasses.

Riley followed behind, his persistent whisper rasping in my ear.

"I went to the psychiatric floor this morning and asked the doctor in
charge if I could interview the patient who'd attacked you."

"Oh, Christ!" I exclaimed, snapping my head around to face him.

"Goddamn it, Riley, that patient should have been left alone--" "Don't
worry, I wasn't allowed near him. But perhaps you could interview him,
when he's better."

At that moment the X-ray team breezed out.

"Okay everybody, he's all yours again," one of them announced. A
radiologist had remained huddled over the monitor, going over the
images. The surgeon joined him, flanked by a circle of residents.
Susanne and the nurses surged back to the patient, surrounding his
stretcher and scanning the readouts of his monitors with their eyes.
My young resident with the penlight broke off from looking at the
angiograms and started poring over the man again, loudly saying his
name, pinching his extremities, and prodding him once more with a
reflex hammer.

I was left standing in front of Riley my face burning. I was furious
at his latest attempt to cross the boundaries of what was appropriate
with patient confidentiality. I certainly didn't want a scene with him
in the middle of my own department, but it took all my self-control not
to raise my voice.

"Now get this. Detective," I began, speaking through clenched teeth.

"Despite your ideas to the contrary, that patient's first and only
violent episode was probably caused by a careless nurse.

If you or I go to him and suggest otherwise, both he and his family
will start worrying he might pick up a scalpel and go after someone
else in the future. Even if we never proved anything, we'd have
disturbed the comfort of his caregivers to have him around them. That
comfort, sir, with schizophrenics, is crucial to their having a life
outside as opposed to their being in an institution. And you and I are
not going to fuck with that delicate balance simply because you we got
a head full of unsubstantiated suspicions."

Riley seemed rocked by my vehemence. Not waiting for him to recover
enough to argue with me, I pivoted and strode away to rejoin my
colleagues.

Minutes later Todd Robbins--I'd learned his name from the chart--was
ready for the OR. As we'd mounted all his monitors and equipment onto
his stretcher for the brief trip upstairs, the man's wife, an
attractive woman who appeared to be in her late thirties, stepped in to
see him for what might be the last time. While I secured the
connections and made last minute adjustments to his IVs, I overheard
her providing what background she could to the surgeon.

"... he's always suffered from migraines, but three weeks ago he had a
different sort of headache.
"Worst in my life," he told me. It was, well, odd because we'd just
made love"--she flushed--"and it came on all at once, with none of the
usual warning signs. That's what he found different. And the pain
being so bad. His usual pills didn't take it away."

"Did he see his doctor?"

"It was Saturday night, and his usual clinic was closed. He even
thought of coming here, but his insurance company insists on
authorizing any visit before they'll pay for it. The nurse on call
said it was probably another migraine, but that if he felt it was
something more serious, by all means go to Emergency. Yet she wouldn't
guarantee payment if it was simply one of his usual headaches. What
really put him off was her warning him that the type of tests he might
needlessly be put through--a CT and a spinal tap, I think she said they
were--could cost two thousand dollars. So we waited. I got laid off
last year, and his job just gets us by, so it's always close to the
line for us financially. By morning his pain was pretty well gone, so
we figured that that nurse had saved us a bundle...."

"Any other medical problems?"

Her eyes began to tear.

"None," she said with a sob.

"He always kidded he had to take good care of himself, because he
wouldn't ever want to seem old.. .." She reached for a tissue in her
purse.

"What's happened to him, Doctor? Will he ..."

At that point I tuned out of their conversation in order to give
instructions to the respiratory technician who'd taken over ventilating
the man from the machine. But I couldn't tune out my thoughts. The
tests he'd been discouraged from having might have saved his life. They
would have picked up the small hemorrhage of blood from an abnormal
bulge, or aneurysm, in one of his cerebral arteries, which had caused
that headache three weeks ago. Such "warning leaks" often precede the
catastrophic type of rupture that had occurred today. Immediate surgery
to remove the deadly malformation back then would have given him a
ninety-five percent chance of surviving intact. Now his chances of
dying were four to one.
* * * When I got back to the nurses station, I found that Riley had
left me a note marked Confidential.

Dear Dr. Garnet, Sorry/or how I acted. I understand your position,
and I'm sure you can understand mine. I would have stayed to apologize
in person, but I had to meet with Mr. Fosse--he wants an update on the
progress of the investigation so far.

Call me as soon as possible, if you figure out how someone might have
pulled off what we discussed.

Riley

I crumpled the paper and tossed it into the nearest wastebasket,
annoyed that the man wasn't taking no for an answer.

But neither could I shake the bug that he'd put in my ear about the
attack being set up, and between seeing patients I found myself
thinking about the purposeful ness of it. Each time my wounds twinged,
I remembered Whitehead waiting quietly outside my office--an hour, he
had said--and wondered how that jibed with a psychotic rage. During a
particularly quiet interlude around midafternoon, I even found myself
sitting at the counter and doodling what in effect was a flowchart of
the murder. Saswald was in the center, and around him, like planets, I
added the names of David, Martin Whitehead, and Brama. It suggested
nothing.

Later I tried again. This time I placed Brama in the center, made
Saswald a planet along with David and Martin Whitehead, and, in keeping
with Riley's thesis that I too might have been an intended victim, I
added my name to an outer orbit. I stared at this design awhile, but
the only thing I could see was what I already knew--that Saswald,
David, and I all had a connection to Brama, albeit mine was a hostile
one. Nevertheless, feeling very silly, I drew an arrow from each of
our names to Brama's. Not wanting to leave out any of the players that
I knew of, I then added the name Baines under that of the company. And
off to one side, but still close to Brama, I wrote clinic.

I studied this version for a while. Absently I drew a line between
David's name and clinic. I was about to join the line between Brama
and the clinic when I thought of the pattern that had struck Riley--how
both the people at Brama and Saswald had not taken kindly to questions
about the clinic.

Their mutual discomfort about anyone mentioning the place was
interesting, I mused.

Thinking about that discomfort caused another name to float into my
head. There was someone else who'd recently given me the impression he
was unwilling to talk about the place, someone who, as far as I knew,
had no connection to Brama. I penciled in Peter Forbes's name among
the orbiting planets.

"Now that's new," I muttered, staring at my diagram.

Absently I added lines between the psychiatrist's name and those of his
two patients.

"But why would Forbes be uneasy about the clinic if he's got nothing to
do with Brama?" I put a question mark between Forbes's name and the
company's.

"Who's got nothing to do with Brama?" asked Susanne, who was
passing.

I instinctively moved to cover what I'd written.

"Nothing, just scribbling."

She arched an eyebrow, but left me alone.

When I looked back down at the paper, I realized what a mess of lines
and squiggles it was, and started feeling silly again. Yet before
wadding it up and throwing it away, I noticed the place where I'd left
out what might be the most controversial line of all--the one between
me and Martin Whitehead.

A psychotic episode or a planned attack?

I entered a question mark.
Chapter 9

"The surgeon said it was the best possible result," a pale and shaken
Mrs. Robbins was telling me a few hours later.

Her dark hair contrasted sharply with her white complexion, and her
eyes were swollen and red. She wasn't crying, but she kept darting a
tissue to them.

"The best possible result," she repeated, forcing a brave smile that
broke my heart.

"And thank you for what you did for Todd," she added, then wheeled
around and fled back upstairs to her husband.

Doctors sometimes use the phrase "best possible result" as code for
"don't expect too much" rather than an expression of hope. I'd spoken
to the OR earlier and learned that they'd retrieved a small bowlful of
clotted blood from what was left of his brain before they repaired the
rupture. The "best possible result" in this case meant making it off
the operating table alive. Left unsaid was the likelihood that even if
he lived, Todd Robbins might never score more than a corpse on a
response test.

As I filled out the insurance forms that we'd omitted to do in the rush
to get the man to surgery, I couldn't help thinking that we could have
saved his life three weeks ago for the same amount of money it would
now cost for having operated on what, to all extent and purposes, was a
dead man. Wanting to scream at the people who were responsible, I
flipped over to the letterhead expecting to get Brama's triage number,
but was surprised to see the logo of a completely different company.


"Son of a bitch," I muttered, dismayed that for the second time in as
many days a firm that I'd mostly had logical dealings with in the past
seemed to be engaging in Bramastyle practices of intimidation. At that
moment I also realized that I hadn't seen a familiar toothless grin
since I'd come on duty.

"Susanne, where's Maggie?" I called out, swiveling my chair around
from where I was writing at the counter.

"Did she finally get admitted?"

Susanne looked up from where she was charting.

"No, she went home before you got in this morning. The overnight staff
cleared her. She was feeling better, and it was perfectly evident her
insurance wasn't going to cover anything more than the ER visit. Under
those circumstances, she wanted out of here

I exhaled my frustration.

"She shouldn't have been discharged!"

"What else could you have done with her?"

"I don't know," I snapped, spinning back around to pick up the phone,
"but surely to God we can do better than letting an insurance company
push an eighty-year-old woman into a corner where she has to risk
losing her house or not get any care at all." Frustrated by my
helplessness to do anything for Maggie, I angrily punched in the phone
number of the people who had played triage roulette with Todd Robbins.
But instead of getting to try to blast some sense into someone at his
managed care outfit who was responsible for authorizing ER visits, I
spent the next twenty minutes being passed from secretary to secretary
like a hockey puck. Finally a funereal- sounding vice president came
on the line. He was courteous, he was sympathetic, but he sounded ice
cold as he reiterated that it was the patient's choice, tragic as it
was, not to go in toER

"Would you have paid for his tests if they'd turned out negative?" I
demanded.

"Our policy is to pay for whatever care a patient needs."
"Decided when? In retrospect, after the diagnosis is known? Your
triage people intimated you'll only pay for patients who turn out to be
sick."

"Of course we don't encourage trivial visits toER, but our medical
panel is competent to decide what investigations are appropriate, and
any necessary test will be provided--" "That isn't the message Todd
Robbins got!"

"I don't think you're in a proper state of mind for a rational
discussion. Dr. Garnet," he declared with a chilling evenness in his
voice, and rang off.

Left with the phone buzzing annoyingly in my ear, I was as disgusted by
the man defending what his triage people had done as I was by his
obvious comfort in doing so. He'd actually sounded practiced at it, as
if such catastrophes had been anticipated--were part of their new way
of doing business-and he'd readied, prepared, and rehearsed himself for
dealing with the fallout. And by his manner, it also seemed pretty
clear that from his company, at least, we could expect more of the
same.

I made a quick swing through the unit, asking the physicians on call if
they'd encountered any evidence of an upsurge in such tactics on the
part of other HMO groups. Some had noticed increased paperwork in
documenting the need for an admission, and others had seen a small
increase in admissions being given only provisional approval, such as
Maggie's. And most had recently come across several patients who'd
delayed coming into the hospital because they were warned by HMO triage
officers that their ER expenses might not be fully covered should their
problem turn out to be trivial.

Until I'd raised the matter, the physicians involved had all thought
these episodes were due to nothing more than poor judgment on the part
of a few individuals in separate health care firms. It was disturbing
to us all when we totaled up our cases and found that the incidents
were common enough to have occurred at least once on all our shifts
over the last week. And in some instances, I also learned, the delays
had done harm.

"... had atypical chest pain, and the postponed trip toER definitely
delayed thrombolytics ..."

"... had a full-blown torsion. Another hour and he would have lost the
testicle .".."

"... was septic with pneumonia by the time we got her..."

Small numbers across the board--hardly noticeable in the hundreds of
cases we see--but in this little group the consequences had been
potentially lethal.

"You think something important's going on?" my associate director,
Michael Popovitch, asked. A heavyset man with permanent fatigue etched
in circles below his eyes, he always looked worried, but I thought I
saw a deepening of the many lines crisscrossing his forehead. Like me,
he was a veteran of the pit. Also like me, he'd been showing the
dark-eyed signs of wear lately.

"Let's keep a watch on how bad it gets," I answered, addressing the
bunch of us who'd huddled together in a quiet corner of ER, "and I want
everyone to report any more such instances to me."

"The trouble with that," Michael said, looking grim, "is that we'll
never know how many people have been scared off to the extent they
never came in at all. What's happened to them?"

The irony of Brama's boycott was that with fewer semi urgent cases, we
had more than enough beds and personnel to handle the big
emergencies--life-threatening catastrophes such as cardiac arrest,
acute respiratory failure, multiple trauma, and penetrating knife or
gunshot wounds. For those problems, the paramedics had complete
discretion over which hospital it was best to head for, and since St.
Paul's always had room these days, we were their favorite
destination.
But between the major resuscitations I had too much time to think and
would quickly become preoccupied with the question that had begun to
plague me most--planned attack or psychotic rage?

Over and over I tried to solve how anyone could have made Martin
Whitehead try to kill me. During one of these sessions I remembered
how he'd called me Satan while he was attacking.

Had somebody played on the religious content of his delusions to
convince him that I was some sort of devil, and then sent him to
destroy me? Yet he certainly hadn't seemed predisposed to listening to
anyone outside his own voices in my office. Hours later, nursing a
coffee through yet another interlude, I wondered if somehow those
voices could have been manipulated, and thereby used to control him by
giving him instructions? I recalled how he'd appeared to be listening
as he towered over me. But what had he said then? I'd been paying
more attention to his scalpel than to his exact words at that moment.
Something about "the voices" that I controlled not being the same as
the one that had told him "to do this," and that I couldn't control
that voice because "it's not here now."

Exasperated, I gave up trying to make sense of his madness.

Schizophrenics often distinguished between their multiple voices,
finding some pleasant to hear, and others frightening-the ones that
tell them to do "bad things."

At home that evening, after a day of doing justice to a week's worth of
caffeine, I found myself sitting at the kitchen table unable to sleep
and thinking some more about the way Whitehead had sought me out.
Although I kept concluding that his behavior prior to the attack just
didn't fit the pattern of a psychotic rage, I was still a far cry from
accepting that someone could have used him to target me. Nevertheless
it was enough to keep me fretting over how such control over him might
have been accomplished. Even when I took Mufiy for a walk and tried to
shove the puzzle from my thoughts I couldn't leave it alone. It kept
popping into my head, like some annoying riddle I couldn't escape. I
went to bed with it;

I got up the next morning with it; I carried it around with me at work.
I eventually grew so frustrated that I even considered breaking my
resolve not to interrogate Whitehead about what had made him come after
me. If it would be just the two of us talking, I reasoned, with no
police around, and I waited until his medication had dampened down his
voices, perhaps I could get some answers without traumatizing the poor
man.

Riley seemed to be having an equally bad time. The fatigue in his eyes
grew as none of his investigators, after questioning staff both in the
hospital and at Brama for hundreds of man-hours, seemed able to come up
with a specific lead.

"I

know Baines is nervous as hell about something," the detective raged
during one of his many visits to my office, "and every instinct I have
tells me the man's up to no good, but I'll be damned if I can find any
hard evidence to suggest why he or anyone at that company would want
Saswald dead."

I poured him a coffee--the nurses had given me my own maker by now--and
offered him my visitor's chair.

"Did your interviews indicate if someone noticed that Saswald himself
was behaving any differently in the weeks leading up to his murder?" I
asked, handing him a steaming cup so black and strong it made even him
wince when he took a sip.

"Not really. We specifically asked the people who he'd worked with if
he was particularly worried or angry about anything. Most said he
seemed stressed in the few days before he was killed, but put it down
to his wrapping up his duties as Chief of Anesthesia."

"What about any long-simmering feuds between him and another staff
member? Every department has its share of those."

"Didn't uncover any. And the only beef that he'd had recently with
anyone besides yourself, as far as I could find out, was a quarrel
between him and your CEO the Wednesday before he died. Fosse's
secretary told me about it, but their argument turned out to have no
relation to the case."
"What happened?"

"According to the secretary. Fosse had called Saswald to his office at
the end of the day, the anesthetist seemed very tense when he arrived,
and they had a huge row behind closed doors. But Fosse explained it
was because Saswald had suddenly announced he'd be resigning without
having given ample notice for the hospital to find a replacement. The
secretary confirmed that immediately after the encounter she'd been
told by Fosse to arrange for the reception, despite her boss being so
furious at the guest of honor. As I said, it all seemed pretty
mundane, from a policeman's point of view. Except of course whatever
the reason was behind Saswald being in such a hurry to get out of here.
Unfortunately, no one could tell me that either."

The following afternoon, during my weekend shift, Riley showed up with
a different lament.

"I never even got those charts upstairs," he told me.

"The court ruled instead that the hospital should contact all patients
named Pearson and ask if they'd agree to talk to the police. Most of
them have, but it's going nowhere. And some, I'm told, are out of
town," he added, pointedly scowling at me.

"We certainly haven't found any patient yet with a connection to the
clinic in Mexico." He leaned forward in his chair.

"Why don't you contact him for us, Doc, and ask if he's willing to
speak with us. That way--" "Forget about it!" I snapped.

"I told you, that patient has nothing to do with the murder."

His eyes flashed and held me in their heat for a few seconds.

I wondered if he'd try to haul me in front of a judge and force me to
give him what he wanted. But slowly that fierce light subsided, and I
saw the muscles along the line of his jaw release the clamp they'd put
on his back teeth.

"You better be right about that, Doc," he warned darkly, "because one
way or another I'm going to get to whoever it is you're protecting and
find out for myself what he or she has to do with this case.

And heaven help you if you've obstructed justice, no matter how
altruistic your reasons."
Shit, I thought after he'd left, wondering what "one way or another"
might involve. Having checked out the majority of patients named
Pearson to no avail, could he now convince a judge to be more
sympathetic in granting access to a smaller number of records--those of
the people who were out of town, for instance, or those of patients
who'd had links with a Brama facility? Or perhaps this time he'd
simply try to get the Mexican police to raid the clinic and arrest a
patient named Pearson?

In any case, the encounter only reinforced my original decision to keep
from him my growing obsession with Martin's attack on me. I'd figure
it out first, I promised myself, and if the young man was used as some
sort of pawn, I'd make sure he wouldn't suffer at the hands of the
police.

By Sunday evening I was so preoccupied with it all that even in bed
Janet was asking what was wrong.

"It's this Brama business," was my reply. Better to trouble her with
an old worry than a new one, I figured, especially if the new one
involved someone wanting me dead.

"But why is Brama bothering you so much more now?"

she pressed, snuggling up beside me and dropping a long leg over mine.
So I told her about Baines trying to badmouth me to Riley.

"Why, that's odious," she declared, beginning to stroke my thigh with
hers.

"But you couldn't be all that upset about something that makes Brama's
executives look guilty."

Then I confessed about how the legacy of Brama was spreading to other
health care companies, affecting people like Maggie and Todd Robbins.

"Now that is worrisome," she said, pausing in her movements as she
became lost in her own thoughts for a while.

Monday morning Susanne met me at the entrance of the nursing station
and led me aside to a quiet corner.

"Just to warn you, the son of Dr. David Pearson is waiting outside
your office." She hesitated, then added, "He looks upset. I hope
it's not bad news."

When I stepped into the hallway leading to my door, I was staggered by
the appearance of the young man seated on a chair. He was the image of
David, but from the time when I knew him as a young, competent
physician long before alcohol had taken its toll. I was also taken
aback to see he was wearing the dark green jacket and trousers of a
U.S. Marine. I suppose I shouldn't have been--the rules by which sons
emulate or oppose their fathers have always proved inscrutable to
me--but I would have thought a boy who'd grown up witnessing the
physical and mental scars David had suffered from war might have come
to a different choice. Three gold braid chevrons on his sleeve above
an insignia of crossed rifles told his rank, but my own ignorance of
military dress kept me from knowing for sure what it was. One thing
was for certain--even if Susanne hadn't warned me, I would have known I
was greeting David's son.

"Mr. Pearson," I said, approaching with my hand held out. I was
unable to remember his first name. The last time I'd seen him, he'd
been barely a teenage boy hovering frightened at the foot of his
father's stretcher during one of the man's many admissions toER.
There'd been a younger sister as well, and the two children had made an
indelible image on me back then, clinging to their mother as David
suddenly began screaming about spiders. Thankfully, both children had
stopped coming after that episode. Years later, so had their mother.

"Dr. Garnet," he said, rising. He was as tall as I was, and
powerfully built, which was no surprise, considering the training he'd
been through. Yet there was a shyness in his smile that was at odds
with how formidable he looked.

"What a fine young man you've become," I enthused as we shook hands.
His grip fit the rest of him, but what I noticed was the worry in his
eyes, which dominated all else.

"I'd like to speak to you about my father, if you have a moment," he
said quietly.
"Of course." Unlocking my door, I braced for the worst.

As soon as he was seated across from me he stated, "He's disappeared
from the addiction treatment center he went to.

They called me nearly two weeks ago to say he ran away, and no one's
heard from him since."

My insides twisted into a knot. Apart from hearing he was dead, I
couldn't imagine worse news. David had not only blown his last chance,
he suddenly no longer had the clinic for an alibi as to his whereabouts
on the night of Saswald's murder. Outwardly I tried to look upbeat,
and started giving him reassurances I didn't believe at all.

"Mr. Pearson, perhaps he'll turn up--" "Please, Dr. Garnet, call me
Alien. And I'm not a kid now.

More than anyone, I know the mortality from alcoholism-I've been
watching it kill him for years. If he's taken off, then he's drunk
somewhere, or already dead." As he spoke his eyes narrowed and his
previously quiet voice rapidly took on an edge.

"Whether this hinge is in Mexico, or he's ended up in a ditch full of
rattlesnakes trying to cross back into the U.S.

without proper papers, he's pretty well run out of luck, chances, or
whatever name hope goes by these days. Personally, I don't possess any
more of the stuff, having spent my lifetime's quota when I was a
kid--hoping he'd make it, hoping that this time he'd do what he said
and not drink anymore, hoping I'd get my daddy back. I've paid too
high a price for learning what I know to let anyone imply I don't know
the score, so you can cut the bullshit."

The bitterness poured out of him like acid, scalding me into feeling
ashamed for not being more forthright.

"I'm sorry. Alien," I quickly apologized.

"I didn't mean to patronize you. Of course you know the reality of his
drinking, and yes, you've every right to demand that I be up-front with
you."

The fire in his eyes died back a little as he studied me.

"Please," I persisted, "let's start again. How can I help?"
He hesitated a few more seconds, then answered, "We-my sister, my
mother, and I--need to know what happened.

I'll be damned if I'll let that uncertainty hang over our lives. I
know I want to get on with mine. I've already wasted enough time
waiting around for things that never happened to be saddled with
wondering if he's dead or sick or just around the corner and about to
walk back in on us. Do you know what I mean?"

I nodded.

He studied me a few seconds more, then said simply, "I need your help
to get by the red tape at the clinic."

"Red tape?"

"I can't get any straight answers. At first they were reasonable
enough, advising my mother that he'd run off, reassuring her that it
sometimes happened, that the isolated locale of the place made it
unlikely he'd go far, especially since they still had his passport and
money in their safe. They also claimed that they'd mobilized all the
local authorities to look for him, and of course we were to call them
immediately if he turned up here."

"When exactly did you say they reported him missing?"

"A week ago last Tuesday, but he'd already been gone three days by
then. Apparently it's their policy not to contact the family
immediately if someone runs away, but to complete the initial stages of
a search first. Nearly a week later, the following Monday, I also got
a call from their head office in San Francisco--the president of the
company, no less, a guy named Baines--and he starts laying on the
schmooze. How upset and worried they were, that if my father turns up
in Buffalo to have him call immediately, that the clinic would readmit
him, no questions asked--personally, I thought it was a con, stroking
us in an attempt to make it less likely we'd raise a stink."

"Baines himself called you?" Now that was odd. I'd heard from
patients how Brama was adept at smooth-talking the families of the
people they'd screwed--part of their publicity budget, I always
suspected. Because even though they couldn't be touched legally, they
were still mighty sensitive about malcontent clients, relatives, and,
needless to say, doctors like me mouthing off about them. But a call
from the president of the company himself was extraordinary. Added to
the suspicions Riley had already raised about the man, Baines's
personal interest in David's disappearance was like an alarm going
off.

Alien caught my incredulity.

"Yeah, I thought the man was piling it on a bit thick myself. In fact,
his reaction made me wonder if there was some kind of recourse we had
that he was nervous about. I dug out my father's copy of the contract
he'd signed--can you believe he insisted that I keep it?

"A reminder that I'm serious this time," he told me--and showed it to a
buddy of mine in law school. In effect, we had nothing, not even our
own health plan anymore. When my father ran away, he'd rendered his
entire policy null and void, including the coverage that extended to
his family."

That sounded like the Brama I knew.

"When did Baines phone you?"

"It was Monday morning around ten. I remember, because when the call
came through at the base, I calculated it was only seven in San
Francisco, and the guy being that eager to speak with me in itself
seemed unusual."

It certainly was.

"But now something even stranger has happened," Alien continued.

"Nobody at Brama will talk to me at all."

"What?"

"Since the day the clinic first called and I spoke with a Dr.

Martinez, the psychiatrist who treated my father, I called back every
few days to see if there was any news. Each time I was put through to
Martinez, and was politely told that though the search was continuing,
there were no developments.

When I tried last Wednesday, he refused to take my call, and a
receptionist told me not to disturb him anymore.
Angry at the brush-off, I called Baines's office in San Francisco,
only to be told he was in Buffalo. But when I repeatedly left messages
with several receptionists at the offices here, he never got back to
me. I even went down to the building to try and see him in person, but
couldn't get by the front door. Go figure. On Monday he can't get up
early enough to speak to me. As of Wednesday, I'm persona non grata. I
can't figure out what happened."

A murder, a cop named Riley pestering Baines with a lot of questions
about the clinic, and me entire police force asking about someone named
Pearson--that was what had happened.

Though why it would make everyone at Brama suddenly not want to talk
with Allen Pearson, I had no idea. Leaning forward in my chair, I
asked, "Did your father ever mention being treated by a physician named
Hector Saswald?"

"Wait a minute. That's the doctor who was murdered here last week.
What's that got to do with my father?" Alien demanded, suddenly
sounding wary.

"I don't think anything, probably, it's just that--" "I told you to
level with me, Dr. Garnet!" His voice was harsh again, and a look of
alarm was spreading across his face.

"My God, that's why the hospital already phoned my mother twice now,
asking would my father please call them regarding a police
investigation when he gets back. The biggest police matter at St.
Paul's right now is the murder--" "Alien, please, believe me, I mean it
when I say that it probably hasn't anything to do with your father. The
police have a lead on the name Pearson, and all patients of that name
who have ever been at St. Paul's are being contacted." As his
expression transformed into one of amazement, I asked, "What did your
mother answer when they called for him?"

"Just that he's out of town. Even though he's gone public with his
alcoholism in the past, she's still ashamed of it, and obviously didn't
want to advertise where he was, or why."
"Good. Now trust me on this. If they phone back, stick to that
answer. Don't even say he's out of the country, and specifically don't
mention Mexico."

"Why?"

"Because even if your father has nothing to do with this, that comment
might give him problems with the police that he doesn't need or deserve
right now."

His eyes narrowed again.

"Tell me why. Dr. Garnet!"

Brother, I thought, I'm not handling any of this well. Still, I
hesitated about how much to say. If I violated Riley's order not to
reveal that Pearson ... too young was written beside the body, and he
found out, the good detective would have my head, if not actual grounds
to carry out his threat of charging me with interfering in a police
investigation. Then for sure I'd end up in front of a judge, forced to
give him the name he wanted. I carefully worded my response.

"Saswald worked for Brama. The police think his killing might have
something to do with the place. They're liable to make a big deal out
of your father being a patient in a Brama facility. It's the last
thing he'd need right now."

"You talk as if you think he's still alive."

"I won't dress a grim situation up for you. Alien, but it is
possible."

He exhaled long and hard, and for the moment let his shoulders slump
out of their military bearing. He leaned forward in his chair and ran
both his hands over his bristly haircut.

"In some ways that's the possibility that haunts me the most. I keep
thinking about him being helpless somewhere, and I want to know what's
been done to look for him.

How hard have they tried? If I could get leave, I'd go down there
myself. But without the cooperation and help of the clinic personnel,
I'd probably get nowhere. That's why I came to ask if you can help me
get through to the people at Brama."

"Alien, I'm not very welcome at Brama myself right now."

He looked up at me and gave a little laugh.

"I understand.
"No-fault murder," right? You really plowed them good with that one.
A lot of people I know felt you were right on the button. That's why I
didn't bother you at first. I figured you wouldn't exactly be someone
who Brama would easily listen to. But now, well, everything else I
tried has come up against a stone wall."

"What about the authorities in Mexico?" I asked, hoping to at least
suggest something useful.

"Again, without someone from the clinic to tell me who they've been
talking to, I'm lost. All I know is the general area where it's
located, just south of the border in the mountains east of Tijuana but
the one police station I could find through information for that
district knew nothing about a David Pearson. I also checked with U.S.
customs. They have no record of him."

"Have you thought of declaring him missing?"

"Yeah, but when I do, word of his running away is bound to reach both
the radio station and newspaper where he works.

His last chance to keep his job with them would be officially over, and
despite what I said about being out of hope, I can't yet bring myself
to write him off to the extent I'd slam a coffin lid on his career." He
gave a sardonic chuckle.

"I know I'm not exactly being consistent right now, but emotionally,
one minute I'm cold as ice, the next I feel like that little boy I told
you I wasn't anymore." His eyes started to brim with tears, and I saw
him clamp his jaw tight and purse his lips, as though his holding them
closed could stem the flow from his eyes. It worked, partially. Only
a single rivulet spilled over the brim of his left lower lid and
coursed down his cheek.

"Sorry," he said, briskly wiping away the evidence of his lapse.

"Besides, what could the police do here that would be of any help,
since he's likely still down there?"

I hoped he was. And now that I thought about it, who knew how police
files were circulated between departments? A missing person's report
involving a man named Pearson who was last seen at an addiction clinic
in Mexico might be passed on to Homicide, and come to Riley's
attention.

"Have you tried one of his other doctors from here?" I inquired. Even
though Forbes had been distinctly unhelpful with me, I wondered if on
learning that David was missing, he might be more sympathetic about
insisting that the clinic give him a proper update on what was being
done to find his former patient.

"The only person in the hospital who's tried to help me so far is Mr.
Fosse. The day after I learned of the disappearance, I met with him.
He immediately agreed to have my father's file number tagged in the
computer so that in the unlikely event he showed up here, we'd be
notified right away. He also tried to help me later, when I went back
to him a second time, after I'd started getting the runaround from
everyone at Brama and in the clinic. I was in his office upstairs when
he actually got Baines on the phone and demanded to know why no one was
giving me or my family any information. He got the same blah blah blah
that I had--all that could be done had been done--that kind of thing,
but he really put the pressure on Baines to do more for us. As for my
father's other doctors, that Arnold Pinter's a wimp, and the
psychiatrist who was treating him is just like everybody at Brama."

"What do you mean?"

"That guy Forbes. He won't return any of my calls either.

He just keeps having his secretary phone me back to pass on the message
that he's heard nothing. Anytime I actually came in person to his
office, the same secretary told me he was with a patient and couldn't
be disturbed. I think he's left instructions for her to keep me away
from him."

"Really?" I said, realizing then that Forbes might have lied to me
about not having any news of David.

"When did you first contact his secretary about your father having run
away?"

"Tuesday afternoon, right after I got nowhere with Dr. Pinter. Why?"
"Because I asked him earlier that same day if he'd heard anything at
all about your father. I'm surprised he didn't call and let me know
that David was missing once he got your message. Frankly, his refusing
to meet with you was absolutely thoughtless and unprofessional." I
didn't confide that I also found the psychiatrist's behavior damn
curious. His distancing himself from Alien was once again mimicking
Brama's course of action. Just as intriguing was the fact that he'd
chosen to keep the news of David to himself.

"Alien, I assure you I'll find out what I can about what happened to
your father, but I have to admit you've already tried everything that I
can think of for the moment, and more." I then promised to call him,
day or night, if I had any news, and we shook hands goodbye.

When he left, I was struck with a curious aftereffect from seeing Alien
and thinking that he looked exactly like David.

Something was niggling at me about my reaction to their similarity, but
I couldn't pin down what it was.

"... so the dolt on triage tries to fudge on authorizing the admission
of my thirty-two-week lady in premature labor," Janet was saying. We
were having lunch at the hospital cafeteria, one of the few occasions
when we'd snatched a common time from our busy schedules to grab a bite
together.

Sharing the table were a group of her friends, mostly women, who were
obstetricians. The dining area we were in was a low-ceilinged, lime
green expanse with fluorescent lighting and seating for three hundred,
most of it taken. The air was full with the smell of onions, the
sounds of cutlery striking plates, and the dull roar of over a hundred
conversations. What we ostensibly came for--the food--was always the
butt of many jokes, as it is in most hospitals, yet most doctors over a
lifetime spend more mealtimes in places like this than they do at home.
For the cafeteria also serves as our village square-a place to learn
the latest news, exchange the most recent gossip, or catch up on the
most interesting cases.
"Wanted to make it 'pending review,"

" Janet continued.

"

"Listen honey," I told her, once the baby's in there, it always comes
out, whether you review it or not."

" Everyone at the table broke into laughter, but accompanied it with
much shaking of heads.

"It's not just Brama anymore," added a woman in surgical greens who was
sitting to Janet's right.

"Haven't you guys noticed how the other companies are trying to pull
the same shit these last few weeks?"

"I'll say," the large man sitting opposite me affirmed.

"One of my women at twenty-five weeks had heartburn and a headache. Her
health company gave her an incredible spiel-"Go toER if you must, yet
we reserve the right not to pay more than the amount normally allotted
for a regular office visit should the diagnosis be simple
indigestion'--but thank God she came in--" "Pre-eclampsia?" the woman
beside Janet asked.

"You got it," he said, nodding, his jowls shaking like wattles as he
slathered more butter onto a roll.

"Would have been seizing, stroking, or dead by now if she'd listened to
the bastards."

Voices came from all directions.

"... a patient of mine was told essentially the same thing..."

"... are the companies colluding? Isn't that illegal..."

"... probably more the ripple effect. Others see what Brama's been
trying, then copycat..."

A tall, redheaded woman who'djust arrived with her tray sat beside me
and exclaimed, "It's scary, all of them pulling that crap. Christ, if
they keep at it, sooner or later the wrong women are going to stay
home, and we're going to have dead babies and mothers. I don't even
want to think about it."

"Maybe you should think about it," Janet countered.

"Maybe we'll all have to organize into IPOs here in Buffalo and take a
stand against these companies the way doctors have in other cities."
The table went silent. In medical circles IPO stood for Independent
Physicians Organization, and was the designation given to doctors'
groups that had coordinated boycotts against particularly ruthless
health maintenance organizations in different parts of the U.S. Every
now and then one of these physicians' bodies had made national
headlines, when enough local doctors in an area refused to sign
contracts with a rogue HMO, forcing the targeted firm out of business.
But such wins were few, and given the whining I'd already heard from a
majority of physicians at St. Paul's, I doubted the backbone for such
a move existed here. Certainly none of the people at the table seemed
thrilled by the prospect.

"You can't be serious," said a sour-faced man farther down the table.

"We're already seeing our incomes cut by the nonsense ER started with
Brama a few weeks ago."

Janet's colleagues all shot sideways glances at me while she leveled an
icy glare at the man.

"You don't think we'll be forced to pull off a similar sort of action
in Buffalo if the nonsense we see now keeps up?" she demanded.

He continued spooning yogurt into his mouth from a small plastic cup,
refusing to look at her.

"I don't think people should start wars that affect a whole hospital
without getting our permission first," he said coldly.

I heard a few people suck in their breaths.

"I'm not interested in starting a war," Janet replied softly.

Her quiet tone had a sharpness to it that I was used to hearing when
she was about to dispose of an idiot.

"I'm simply suggesting we could use some advice right now from people
who have already been through that kind of fight. Tactics, legal
strategy, how to protect ourselves and our patients--who knows what
we'll need if it comes to a showdown with these companies. Brama, for
instance, seems not only capable of playing hardball, but dirty as
well."

Murmurs of approval rose up around the table.

"Right, Janet."
"Well said."

"Good point."

Her opponent glowered at her, threw his empty yogurt container on the
tray, and angrily got up from the table. As he strode by my chair he
muttered, "What's the matter. Garnet, can't fight your own battles!"

"Hey! That's a cheap shot," the woman beside me protested to his
retreating back.

The man opposite me added, "Pay no attention to him, Earl."

"What a sourpuss," the redheaded woman proclaimed between slurps of
soup.

Yet it was a testy few seconds.

As was the case with almost every doctor in the hospital, all these
physicians would have lost some business because of the boycott. Some,
I suspected, were as furious with me as the man who'd just stomped off,
and had only refrained from saying or intimating anything out of
politeness to Janet.

But I also knew Janet hardly ever blundered into uncomfortable moments
by accident, and I had a sneaking suspicion she'd used her funny story
to deliberately stir up a discussion about HMOs. Throw the issue in
their faces, provoke them to look at more than the money they were
losing, then make anyone who still protested look like an asshole--it
was the kind of step-by-step plan I could imagine her thinking up.

"Why don't you call that friend of yours in San Francisco, Earl?" Janet
said breezily, diving into a second helping of spaghetti as if nothing
had happened.

"You know, the one who organized local physicians against the HMOs
there. He came to our wedding on a Harley. What's his name?"

She knew the name of the man as well as I did, and must have something
else up her sleeve, I thought. Taking my cue, I answered, "You mean
Jack MacGregor?"

"Yeah, that's the guy. I can never remember his name.

Probably because I never liked him."
"Janet!" I laughed.

"I don't. He never got over the sixties, and I don't think he ever got
over me marrying you and making you respectable."

"Jack's a great guy," I said. Her colleagues seemed to be enjoying my
being put on the defensive.

"Great guy, my ass. I always get the feeling he's trying to lure you
into a motorcycle quest through Afghanistan or somewhere to set up free
clinics."

Everyone at the table, relaxed again, was chortling now. It was
vintage Janet keeping me in my place.

"Come on." I grinned.

"You're nothing but a prop to him, so he can relive his wild old
days--admit it!"

I started to chuckle. Jack had been my best friend in medical school,
and indeed was a free spirit. He'd never married, never settled, and
as far as Janet was concerned, whenever he visited, which was less and
less, it was really to disapprove of me for selling out. And while
there was a certain amount of truth in her take of him, she wasn't
completely right about him either.

"See, that proves it," she declared victoriously.

"You always have that nervous laugh when you know I'm right. Come on,
confess it! And since we had the audacity to have a baby, he's stopped
coming around altogether. Tell me I'm wrong."

"His not coming around has nothing to do with your attitude toward
him?" I suggested, trying to sound ironic.

"My attitude?" Janet exclaimed in mock horror, fluttering her
eyelashes and fanning her face with her hand.

"Why, I've never so much as deviated from treating him with the utmost
politeness."

There were hoots of laughter from the other women.

"Gal, who'd you ever treat with the 'utmost of politeness'?" teased
the one sitting next to me, the faint wrinkles around her eyes
thickening into laugh lines.

"I swear I've been nice," Janet declared with a sly grin.
"I'd like to see how you'd treat a guy who came to your wedding
wearing a motorcycle jacket."

"I remember him!" piped up a slim blond lady about Janet's age who was
sitting at the end of the table.

"He was outrageous.

Sat beside me at the dinner and spent the whole time trying to convince
me that riding a motorcycle was an aphrodisiac.

Wanted me to run off to Canada with him for the rest of the weekend."

"He had a lot of nerve!" the woman beside me huffed.

"I'll say," came the reply.

"I had to pay the gas the whole way."

This time we all shrieked with laughter.

"You went with him?" Janet howled, looking delighted.

"Of course. He was fun; I was young."

They continued to tease and joke with each other.

"So why do you want Earl to phone Jack?" the outspoken lady asked.

"Not that I'd be interested in him, at my age," she added with a
wicked, deep-throated chuckle.

"In a word, Brama," Janet said.

"They've been so unreasonable lately, and Jack MacGregor--" "Boy, I'll
say they have," interrupted a fifth woman, with shoulder-length gray
hair. She was just joining us.

"One of my patients with third-trimester bleeding didn't come in on the
weekend because she only got a provisional clearance.

What the ruck's going on?"

"My dear, it's the new world of managed care in Buffalo," the portly
man opposite me said, mimicking W. C. Fields as he wolfed down yet
another bun.

"That's why I think we need to consult someone who's been through this
shit," Janet continued.

"The last time good of Jack was visiting us, besides trying to entice
my husband to abandon domestic bliss and take to the highway with him,
he boasted a lot about his setting up the first successful IPO in
California. I thought it was his usual bullshit and tuned most of it
out, but a few months later I started reading about the guy in some of
those glossy medical posts we get. It impressed the hell out of me
that he had actually succeeded in organizing enough physicians that
they'd made their local HMOs toe the line about not messing with
emergencies."

"Hey, I remember reading that," said the woman sitting beside Janet.

"You're right, it was incredible. Doubly so that he'd pulled it off in
Drama's backyard. San Francisco's the one city where ER visits are
covered, no exceptions."

Chewing vigorously, his mouth still half full from his previous bite,
the man opposite turned to me and asked, "Any chance you could get him
to come and address all the physicians here. Earl? It might be
exactly what we need at St.

Paul's, if we've a hope in hell of standing up to these guys."

There were murmurs of approval.

"... speak to other hospitals as well.. ."

"... wouldn't that be great, to get the upper hand again..."

"... but do enough of us have the guts..."

Then the woman beside me cracked a wicked grin and said to the doctor
at the end of the table, "So is it?"

"Is what?" she replied, a spoonful of soup halfway to her mouth.

"Is a motorcycle an aphrodisiac?"

The hoots of laughter made everyone else in the cafeteria look over at
our table.

"Ladies," I said, grinning, "I think I'll leave you to what's obviously
going to become ^.professional discussion."

With humor and nerve, Janet had planted a seed. What was unthinkable
to those few doctors--standing up to the likes of Brama--had suddenly
become a possibility to be considered.

They'd talk. The idea would spread. And object lesson or not, Janet's
suggestion to phone Jack was a good one, if indeed we could whip up
sufficient interest among Buffalo-area physicians to at least consider
some form of coordinated action.

He'd had twenty years of experience being a thorn in the side
ofHMOs, and in San Francisco he'd been a voice of patients' rights for
more than this past decade.

It was also far too long since we'd last talked.

Jack and I had clicked in medical school, shared a passion for ERin
residency, and given five minutes together, even after not seeing each
other for ages, we could be fast friends again over a beer. Janet was
right--he didn't come around anymore because our lives were so
disparate, but not because he disapproved.

"Let's spare ourselves the embarrassment, Garnet," he told me after his
last disastrous visit, when he'd been like a foreign body in our
domestic way of life.

"You wouldn't fit in my world of after-hours joints and multiple lady
friends either. If we happen to meet by chance, great.

We'll raise a drink and toast our marvelous luck to be doing what we
love, but no more arranged get-tog ethers for you and me, chum." Since
that pronouncement, we'd pretty well stayed on our separate paths, but
the rare times we did run into each other, we always managed to pick up
the conversation where we had last left off. What was behind our
friendship?

Respect was part of it, I think. From the time we were first students
together, we both adored being good at our work and were never a threat
to each other with our successes. Instead, our abilities seemed a
match, and whenever he excelled, it made me feel more confident that I
could do the same. And Jack loved to laugh. His zaniness not only
helped keep me sane during the rigors of residency, but even a half
hour with him when we occasionally met later seemed to lighten the load
of moving into middle age.

I retreated to my office and got the number for his hospital, Santa
Magdalena, where he was Chief of ER.

"Dr. MacGregor is no longer on staff," intoned a receptionist for the
emergency department.

"Would you like to speak to the current director?"

"Yes, please," I said, taken by surprise. Jack hadn't intimated a move
was afoot when I'd last seen him. That was over a year ago at a
conference out West. But opportunities can crop up unexpectedly, and
fast moves aren't unheard of in our field. Someone of Jack's caliber
would always be receiving offers.

I heard the receiver click.

"Hello, Dr. Ross here." The greeting was exhaled, like a sigh. The
man sounded tired, and in the background I could hear the familiar
sounds of emergency:

beeping monitors, shouted orders, a distant siren.

"Sorry to trouble you, but my name's Dr. Earl Garnet, and I'm looking
for Jack MacGregor. I wondered if anyone there--" "He doesn't work
here anymore," he interrupted.

"Hasn't for the better part of a year."

"Do you know where I can reach him?"

"No idea. Now if you'll excuse me, we just got an ambulance."

"Does he have a forwarding address?"

"Look, I've got to go. Try Personnel." He hung up.

Annoyed, I again dialed me main number, and asked the operator who I
should speak with if I wanted the forwarding address of a former staff
member. She gave me the mailing office.

"We haven't had anything for Dr. MacGregor these last six months," a
pleasant-sounding woman told me.

"I'd have to check our records to see if we still have his card, but if
I remember correctly, I think even that was simply a P.O. box.

Can I get back to you?"

"Would you normally have his phone number with his address card?"

"No, but Administration should have that on record still, and also his
address, for that matter. They always keep track of where doctors have
gone, in case of lawsuits. I'll transfer you."

I was passed through a series of more clicks to an equally sunny-voiced
woman who nevertheless gave me the third degree as to who I was. After
I'd recited my pedigree and given her multiple reassurances I was an
old friend, I convinced her to relinquish what I wanted.

His mailing address was indeed a post office box. When I called the
telephone number she'd given me, a very sincere but recorded voice
apologized and told me the phone was no longer in service. A check
with directory assistance failed to come up with a new listing for
him.

I figured there had to be someone in the ER who knew what had happened
and where he was.

I called Santa Magdalena yet again, and this time requested the head
nurse.

"I haven't heard anything from him since he was dismissed, Dr. Garnet,"
the man who came on the line confided.

"There was some big blowup, then he was gone. Rumors had it that he
was charged with having stolen some documents, but it was all
hush-hush. I have to tell you, my nurses were really upset. And after
his having had such a high profile in this city, it's doubly shocking
that he seems to have fallen off the face of the earth."

"No one's heard from him, not even the other doctors?"

"Not that I know of. But 1 could ask around if you like. Do you want
to leave me your number?"

I gave them all to him--my office, hospital locating, the cellular,
even our private listing at home.

"If you find Jack, say hello for me," the nurse said before he hung
up.

I sat at my desk for a few minutes, stunned. Stolen documents?

Sudden dismissal? Fallen off the face of the earth?

I had to reach him. I went to a filing cabinet where I kept handouts
from past conferences I'd attended and found the material from the
meeting where I'd last seen Jack. We'd been kidding each other about
being among the last of the dinosaurs to get e-mail, and he had
sheepishly given me his card with an electronic address emblazoned on
it. I'd never used it to contact him, as a way of "outdinosauring" my
old friend, but I dug it out of the folder now, flipped on my computer,
and sent off a message that he call me urgently. The icon that would
normally signal returned mail didn't flash, so I had reason to hope
that wherever he'd ended up, and whatever had happened to him, the Net
would find him for me.

Then, to be sure, I scribbled the same message on paper and posted it
slow mail.
Chapter 10

"Fired for stealing records?"

"That's what his head nurse said."

"But that's--so bizarre!"

"Bizzzzzz," copied Brendan, waving his fork in the air.

Janet and I were having dinner in our kitchen. Brendan was
thoughtfully picking through his cut meat and joining in our
conversation.

"You bet it's bizzzzzzarre," I said, putting my face close to his and
making him laugh while feeling far from humorous myself.

"But would he do something like that--steal papers? And why?"

I flashed back to when we were rooming together in the late sixties.
There were always members of various movements or popular crusades
sleeping on our floor at his invitation, some of whom were draft
dodgers and deserters he was helping escape to Canada.

"Yeah, he'd take a few shortcuts outside the law, if he thought it was
for a good cause."

As Janet frowned, Brendan studied her somber face, then cocked his
head, leaned toward her, and gave her a goofy grin she couldn't resist.
She ruffled his hair.

"Thank you for cheering me up, my little man." He offered her a
forkful of mashed carrots. As she took it from him, smacking her lips
in a noisy display of appreciation, she turned to me and added, "You
know, I like what you like in the man, even though I find him
impossible to be around for any length of time." 157 "Really?"

"Of course. He's a fighter--a real-life Don Quixote--and thank God for
nuts like him to take on the skirmishes the rest of us don't have time
for." She picked up a spoon and offered some of the yellow mush to
Brendan's open mouth.

"I meant what I said at lunch today. Earl. He made a big difference
for patients in his hometown, and the more I look at how we might have
to fight the same fight here, the more impressive his feat seems." Her
frown returned.

"It's such an ignominious way to leave the field, for a guy who's
already accomplished something that difficult to bring about, which is
so important. And it's such a huge waste of his experience.

Frankly, the thought of squaring off with these companies and not
having the help of someone like Jack, who's been through it,
intimidates the hell out of me."

Her words gave me an idea.

"Hey! If I find him, why don't I offer him a job in ERat St. Paul's,
and then he could lead us through what needs doing."

Janet grinned at Brendan, pointing her now empty spoon at me.

"Your dad's a little slow, my sweet man, but eventually he can pick up
a good idea if we give him enough hints. But of course later on he'll
swear he thought it up himself."

On the car radio going into work the next morning, all the newscasts
were reporting on a press conference being held by a local patients'
rights group.

"... HMOs deterring sick people from ERs with threats of reneging on
their coverage..."

"... an odious practice not previously seen in upstate New York, but
one which has plagued the Southwest..."

"... that current laws permit such behavior on the part of health
insurance companies ..."

Obviously the citizens of Buffalo had started to notice the trend.
By the time I arrived at St. Paul's, the same reporters who'd pressed
me for further comments about no-fault murder three weeks ago were
calling to see if I had anything to say about today's developments.
After a second's hesitation I replied, "I also find this practice of
intimidating patients dangerous, and it appears that all local
insurance agencies are beginning to dabble in it." Normally I detested
making headlines about ER matters, preferring to deal with the
important issues of emergency in a professional forum--a scientific
meeting or assembly--and letting the media cover messages from a full
range of speakers. But as Janet had made clear last night, these were
not normal times.

The woman on the phone seemed caught off guard that I had anything to
say at all.

"Uh, could you elaborate on that, and can I tape our conversation?"

"Certainly. Are you ready?" I heard a few clicks, got her okay, and
continued.

"Unless the people of this city and members of the medical profession
act decisively, then such practices may become the norm here, as they
have in other communities. We have to let the CEOs responsible for
this odious policy know that we won't tolerate profit-taking on the
backs of patients' rights to emergency care."

"What sort of action do you suggest?" she asked, the excitement in her
voice making it clear she liked my comment and was eager for more.

"These are powerful companies, but they understand one thing--money. If
enough doctors refused to work for outfits denying unconditional access
to emergency care, and if patients withdrew from programs that didn't
provide such coverage, the companies would be forced to back off. Such
action has proved successful in other U.S. centers, but unfortunately,
it's rare to get the necessary level of participation from physicians
to pull it off."

"Is there anything else that could make a difference?"

The answer popped into my head. To people like William Baines, it
would be an even more upsetting broadside than no-fault murder, and my
saying it could ignite a much bigger backlash from the insurance
industry than what was happening already. Spit it out anyway? I
wondered. Fosse had warned that my only hope of surviving Brama's
campaign to get me fired would be to challenge them head-on. But it
was a flashback to seeing the remains of little Robert Delany that gave
me the deciding push.

"Yes, there is something," I declared, "that would give patients enough
power to check the kind of unscrupulous profit-taking which leads to
withheld care. It's called right-to-sue legislation."

By noon I was being quoted on newscasts all over the city.

Soon the entire hospital was buzzing with the controversy.

More reporters were calling, wanting further interviews, and
invitations to appear as a talk show guest started pouring in.

On a television set in our waiting room I even caught news clips of
various grim-faced CEOs from local HMO offices issuing terse "No
comment" declarations after the media had tracked them down. I took a
certain satisfaction in seeing them run for their cars pursued by
camera crews.

But by three that afternoon I was sandbagged by a completely different
problem.

"You what!" I screamed into the phone.

"I told you, I talked with him, with his mother present."

"I swear, Riley, if you've upset that young man's equilibrium, with
himself or his family, I'll--" "Doc, settle down and give me some
credit. I cleared it with Fosse, after explaining to him why I was
suspicious about the timing of Martin Whitehead's attack on you. He
agreed it was important to follow up on it, and spoke with Mrs.
Whitehead. He was also there for what was just a preliminary
meeting."

"Jesus Christ," I muttered through my teeth, knowing how even just two
strangers entering his room could be terrifying for an unstable
schizophrenic.
"We simply said hello. Doc. It was a first get-together, to become
acquainted. He certainly didn't seem too bad--not at all what you
encountered--and he shook my hand."

"You can't judge his state of mind by the same behavioral standards
you're used to seeing in others," I told him, exasperated.

"That's why I want you with me. Doc, for a proper interview.

The mother agreed to that, provided it's you who's running the show. I
have to tell you, she and her husband think a lot of you. They both
can be at the hospital nine tomorrow morning, if that's convenient for
you."

I sighed noisily. Riley's barging ahead had messed up my best
intentions to protect Martin Whitehead from the police and exactly this
kind of ordeal.

"Doc, listen to me," the detective continued.

"That young man has heard from the nurses what happened with the
medication and that it wasn't his fault what he did, but from the bit
of conversation we had together, he still seems terribly troubled by it
all. He told me himself he was ashamed to face you, that he even
feared you might be mad at him. When I assured him that you understood
it was an accident, I swear he looked relieved, though like you say,
it's hard to tell with him. His expression doesn't give away much."

Riley had picked up on what we call the flattening of affect--a lack of
showing emotion--which is common to schizophrenics. I found myself
giving him credit for at least being astute enough to make the
observation.

"Now, Doc, I'm no psychiatrist," he went on, "but even if this guy
doesn't show feelings like the rest of us, I'm pretty sure he's hurting
inside, thinking about what he did. Talking about it with you, on the
other hand, and seeing for himself that you don't blame him, I figure
that's got to make the guy rest a little easier, and might even help
him get on with the business of making it out of here."

Well, son of a gun, I thought. Surprised by Riley's intuitiveness,
again not exactly what I'd come to expect from the bulldog detective,
I relented.

"I'll be there at nine," I told him crossly.

What I didn't say was that if he kept showing such traits of insight
and sensitivity, he'd have to turn in his rubber hose.

More requests for TV and radio interviews continued to come in
throughout the afternoon. I thanked the callers for their interest and
told them I'd get back to them after I consulted my schedule. What I
really wanted was time to discuss with Janet how far I should go with
what I'd started. Already the furor was giving me second thoughts
about the wisdom of speaking out in the first place. And I began to
worry what the effects on Janet might be if she got caught in the
middle between me and the inevitable retaliation of local HMOs.

Just as I was leaving for home, my computer signaled that I had an
e-mail message. Thinking it might be David responding already, I
eagerly clicked open my file, but saw instead a memo from Fosse.

Listened to your interview.

Well done! Remember the Board Meeting tomorrow.

4:00 p.m.

Bring armor.

On the evening news my comments about HMOs were the lead story again.

"It seems I have my own Don Quixote " Janet said, snuggling up to me on
the couch as we watched.

"Do I do more? The media are all over me."

"Of course," she said without the slightest hesitation.

"The harder you keep hitting them now, the louder the public outcry is
likely to be, and the better our chances of making them back down."
Then she grinned and added, "Can I be your sidekick?

I'll hum "The Impossible Dream' wherever you go."

"You don't seem the spear-carrier type to me."

"Of course I'm not. But listen to this voice.

"Climb every mountain--'"
"That's from The Sound of Music."

"So who cares? It's quest music, right?

"Swim every sea--' " "The line's "Ford every stream."

" "Stickler!"

By the time she got to the chorus, I had sore sides from laughing and
my stitches were in danger of coming out. But I suspected her levity
was all show. Later that evening, when I came up to the nursery, I
stood at the doorway and watched her rocking Brendan to sleep. Normally
her face exuded peace during this ritual, but tonight I was startled to
see her expression drawn and lined as she stared out the window.

The call came shortly after. Luckily I was the one who answered.

"Earl Garnet?" said a raspy voice.

"Yes?" We had an unlisted number, so I expected it to be someone from
the hospital.

"We can get to your wife. Be smart, and shut the fuck up!"

"Who are you?"

""Ybur worst nightmare. Garnet! I'm a whole bunch of people who
you've pissed off." The whisper grew in volume until it became a
sibilant shriek.

"Remember, it's your wife who'll pay!"

"Who the hell are you?" I yelled back.

A harsh chortling noise came through the line, then I heard a click and
the dial tone.

I had Riley on the phone in less than a minute.

"I'll get a patrol car outside your house immediately," he stated as
soon as I related what had happened, "and I'd like your permission to
put a tap on your line."

"Of course."

"Do you think the threat is because of what you've been saying about
HMOs?"

"Isn't that obvious?"

He heaved out one of his massive sighs.

"Maybe not. Have you discussed your suspicions about the clinic in
Mexico with anyone besides me?"
"No, not really." I tried to remember exactly what I'd said to Alien
Pearson. I was sure I'd only warned him not to mention that his father
had been a patient there.

"What do you mean, not really?" Riley snapped.

"I mean no, I didn't, period." Boy, he was quick on the uptake.

"Doc, this is not the time to hold back information, even if there is
another of your patient-confidentiality issues at stake. Yours and
Janet's safety depends on you being straight with me."

His bluntness about Janet made me wince.

"I am being straight," I assured him.

His silence told me he suspected otherwise. Finally, after sighing yet
again as if attempting to exhale his frustration, he elaborated.

"Suppose I'm right that the questions I asked Baines and his CEO about
the clinic precipitated an attempt on your life. That would mean the
killer fears such questions, probably because he thinks they could
expose what was behind Saswald's murder. It also means he knows you're
the one raising the questions. Since that person's first attempt to
get rid of you failed, it would be convenient for him that every HMO in
the area has just declared you public enemy number one. A threatening
phone call sounding like a response to what you've been saying to the
media today would make any future attempt on you seem part of that
business, with a lot of ready suspects at hand." He paused a few
seconds, presumably to let me mull over what he'd suggested. Then he
asked, "Have you told Janet about the threat?"

"No. I called you first."

"Are you going to?"

This time I let out the sigh.

"It'll scare her."

"Damn it. Doc, she has a right to know. How else can she protect
herself. Now you tell her, understand?"

His sudden fierceness caught me by surprise, then left me feeling
sheepish for not knowing better.

"Yeah, of course you're right. She has to know."
"Okay, then. Now this will sound trite, but try not to worry.

That patrol car at your home will become a fixture day and night until
this whole situation is settled." His voice was all at once gentle,
and remarkably reassuring.

"Detective, I ... I appreciate your help, and your setting me straight
about Janet."

"Think nothing of it. Doc. There, I've got an advantage over you.
When women started coming on the force, I took all the courses on how
to treat them as equals."

When I told her of the threat, Janet took it as she always took
difficult news--quietly, and with steely silence. I didn't expound to
her Riley's theory that it might be tied in with the murder. Despite
his advice to be forthright, I figured once she was warned enough to be
on her guard, there was no point of adding further unknowns to her
worry.

"Well, I guess it's started," was all she said after a few minutes.

"And you're sure a marked police car will be parked out front from now
on?"

From the alarm I saw in her eyes, I suspected she was thinking
ofBrendan's safety. She was too fearless personally to ever be that
concerned for her own.

"I have Riley's word on that, plus they're going to put a tracer on our
line," I reassured her.

During the night, I woke to her holding me in her sleep again. Lying
awake, I listened to her breathing and occasionally felt her stir
against me. This time I hardly even noticed my stitches.

Martin's wide eyes stared up at me, beseeching acceptance the way a
puppy might. His short black hair was neatly combed, and his massive
shoulders which had so intimidated me now slouched submissively as he
sat on the side of his bed. He was dressed in a polo shirt and slacks,
having graduated from being restricted to wearing only a housecoat on
the floor. Behind us Riley was leaning against the windowsill
while Mr. and Mrs. Whitehead occupied the two sole chairs for
visitors, each occupying a corner in the room. Having just arrived,
after saying hello to the others I stepped up to Martin, my hand
extended, and said, "Good morning. I'm glad to see you're feeling
better."

His shake was limp, and I felt the clammy coolness of his skin that was
an occasional side effect of antipsychotic medication.

"Hello, Dr. Garnet," he replied so softly that I could barely hear
him. He then looked down at his lap.

"May I sit beside you?" I asked, speaking almost as quietly.

He nodded without looking at me, and I eased myself onto the bed as
near to its end as I could so as not to crowd him. I waited a few
seconds until I saw him take a quick glance my way from under his
lowered eyelids, then spoke.

"Martin, I know that what happened was not your fault. And please
understand that Detective Riley and myself also appreciate your
agreeing to answer our questions."

"Are the police mad at me, Dr. Garnet?" he asked, his voice void of
any inflection.

"No, they're mad at someone else. Someone who perhaps deliberately
mixed up your medication."

"You think someone did that? Who? And why would they?"

I didn't know how to answer without upsetting him.

"Someone who wanted to hurt me, Martin," I replied after a few seconds'
thought.

"That person may have tried to trick you into doing something you'd
never do on your own. A low sugar makes people violent. Martin--" "I
know. Dr. Garnet. After the nurses explained what had happened, I
read about the hypoglycemic medication in some medical books I have--my
parents brought them in for me from home. Glyburide, it was--peak
onset of action three to four hours after ingestion. That means it was
given to me between three and four that afternoon."

I very quickly realized that Martin was not only bright but
surprisingly literate. Some patients with his disorder isolate
themselves even from reading.

"I'm impressed, Martin. Not many people can understand material--"
"I've read all about schizophrenia too. Dr. Garnet. I know what
medications I take, and what happens if I don't stay on them. I figure
the glyburide was slipped in with my usual pills given at three. I
wouldn't have noticed. I usually down them all at once, not like some
who take them one at a time."

"Who gave you the pills?"

"One of the nurses brought them to Dr. Forbes's office. We were
having a session together that afternoon. I'd just gotten out of
isolation the day before, so he was meeting with me to see how I was
doing."

"How did you feel then?"

He looked at me sideways, then back at his hands, which he kept rubbing
together.

"Not good," he said softly. He remained silent a few seconds.

"The bad voices were telling me things, swearing, saying everyone was
going to hurt me."

"Did you tell Dr. Forbes about the voices?"

He started to rock.

"Yeah."

"What did he say?"

"That they wouldn't do anything to me. That I was safe."

"Were the voices saying anything about me while you were with Dr.
Forbes?"

"No. That voice came later."

"That voice? It was a single voice?"

"Yeah." His rocking and hand-wringing intensified.

"Did you ever have singular voices before?"

"Sometimes they shout in my head, and argue together, the good voices
with the bad." He paused, then added, "That scares me."

"But the good voices don't?"

"Yeah. I like them. They sing nice songs, tell me I'm going to be
okay."
"Do you have the good voices now?"

"A bit. I don't like it when the medication makes them go away
completely. It's too lonely" "When did you start hearing the voice
which told you to attack me?"

His rocking picked up tempo. I noticed he was now looking over at the
telephone on his nightstand.

"In this room, after I got back. It told me that you were an agent of
Satan, and that tonight you were going to slip into my room to cut my
throat as a sacrifice to your master. The voice said you'd been
fooling everyone for years, but that you killed people like me when we
came through your Emergency. The voice revealed that you'd picked me
to die years before, when you treated me yourself, but you'd waited, so
no one would suspect.

He ordered me to kill you before you killed me." The pace of his
speech was speeding up.

"He proclaimed that he was an avenging angel of God, that he'd chosen
me to serve as his instrument of retribution on Earth. I didn't want
to hurt you, but he said if I didn't, I'd burn in Hell. That he'd sear
my eyes out. Melt my flesh off my bones." The back and forth movement
was becoming forceful enough to shake the bed.

His breathing quickened and he was wringing his hands so fast now that
he appeared to be washing them.

Hoping to calm him, I quickly said, "We'll stop. If this is upsetting
you--" "I was scared!" he cried out, his voice as loud as when he'd
shouted at me in my office.

"It's okay, Martin," his mother intervened, getting up and walking over
to the other side of the bed.

"Dad and I are here," she reassured him, starting to massage his
shoulders.

"You're safe, dear. Everything's all right."

The effect was immediate. His breathing slowed, his hands went still,
and he leaned back against the woman, no longer rocking. After a
minute of soothing him in this way, she calmly said, "I think you can
continue now. Dr. Garnet."
"Are you sure you're ready to talk some more?" I asked, taken aback
by how brittle his equilibrium was.

"Yes, Doctor." His tone was flat.

Despite what he said, I knew my questioning him further might unsettle
him again. I proceeded, but very cautiously.

"How else did you feel, besides scared?"

"Hungry," was all he said at first, while still staring at the phone.
Then he added, "Dizzy too, and sweaty."

These were symptoms of hypoglycemia

"What else did the voice say?"

"That I was to go down to Emergency, find the door with your name on it
where the offices are, and wait for you to show up. When you did, I
was to say that I was being discharged the next day and that I wanted
to speak with you, until I got you alone. Then I was to cut you open
and spill your blood, thereby sanctifying your evil ground." His voice
was absolutely neutral. He might have been telling me how he was sent
to a store to buy some milk.

"Had one of your voices ever given you instructions like that
before?"

"No, never like that."

"But you got instructions."

"Yes."

"What kind?"

His eyes returned to his now-still hands.

"Long instructions-how many steps to take forward, how many times to
sit down, to bow right, then left--that kind of thing."

Schizophrenics could sometimes be seen carrying out long, involved
repetitive rituals of movement and speech, dictated by their auditory
hallucinations. But the sequence of detailed directions he'd described
pertaining to me were unlike anything I'd ever heard from a
hallucinating patient. Nor had I ever read of a psychotic episode
where "voices" had set up such a carefully laid-out act of violence.
The only case that sprang to mind was the famous Son of Sam killer who
stalked parked couples in New York City. But as much as I could
remember from reading in the papers about it back then, not even he got
such specific advice from "Sam," his guiding demon. Something very
definitely didn't add up with what Martin had experienced.

"Where did you get the scalpel?" I asked next.

"It was in the drawer of that table," he said matter-of factly nodding
toward the nightstand.

"The voice told me it was the chosen sword of the Lord."

"You found the scalpel in the bedside table?" I blurted, far too
loudly. At that same instant I heard Riley stir from where he was
sitting at the window and quickly come up behind me.

Martin cringed at the change in us, and he leaned back into his
mother.

"Sorry," I quickly apologized, lowering my voice.

"I didn't mean to startle you."

After a few seconds of looking from the detective to me, and his mother
murmuring comforting sounds in his ear, he muttered, "Yeah. It's okay.
That part of what happened has been bothering me too. If it was all in
my head, there wouldn't have been a scalpel."

"You've got that right," I heard Riley mutter behind me.

"Do you remember at all being in my office?"

"What happened at that point starts getting pretty vague."

"Were you hearing the voice telling you to kill me then?"

"No, I don't think so. But I was afraid to disobey. It had scared me
so much. I just remember getting more and more frightened, dizzy, and
light-headed once I got you alone." He paused and made repeated
swallowing movements. A dry mouth was yet another side effect of his
pills.

While I waited until he found enough saliva to continue speaking, my
mind was racing. Increased effort can profoundly accelerate the
development of hypoglycemia in a non diabetic after his taking a
product like glyburide. As he'd sat quietly outside my office, the
pill would have already been steadily doing its work, lowering his
blood sugar to subnormal levels, yet not necessarily enough to alter
his mentation. But with the sudden effort of attacking me, his body's
demand for additional energy would have plummeted his glucose to the
exceedingly low range, thus setting off his violent behavior.

Left unchecked, such severe hypoglycemia can result in seizures, coma,
and death. With a shiver I realized that if Martin's hypoglycemia had
been induced to help manipulate him into making an attempt on my life,
then very likely my would-be assassin had intended him to conveniently
die as well.

"Dr. Garnet," he resumed, "the nurses said I cut you." His
articulation sounded labored from lack of spit.

"I don't remember doing that at all." He looked up from his hands.
Although his face was expressionless, his eyes no longer shared that
same blankness. Instead they were full of pain, like open wounds, and
I couldn't bear looking at them.

"Did I hurt you badly?" he asked.

I tried for a reassuring smile.

"No. They were superficial cuts. A little stitching fixed me up
fine."

He continued to study me with that dreadful stare.

I changed tack and went on to less stressful matters.

"Did you tell anybody about all this?" If he had, I wanted to know
what idiot hadn't reported what was obviously a bizarre account, to say
the least, and clearly beyond the bounds of what could be explained as
part of his psychosis.

"Nobody asked about it before you."

"Not even Dr. Fortes?" It would be awfully lax for a therapist not to
explore other factors that might have contributed to his patient going
berserk, over and above the effects of hypoglycemia.

"No. He never asked me anything."

"Not even about where you got the scalpel?" Riley demanded, speaking
over my shoulder.

"No sir," Martin said, shaking his head.
I heard Riley suck in his breath behind me. Then he asked, "Was there
anything that struck you as odd about this voice that told you to
attack Dr. Garnet?"

"Yeah. It was how the voice came over the phone."

"Over the phone!" Riley exclaimed, his voice rising.

"How do you mean, 'over the phone'?"

"I mean this voice came out of the phone--whispering at me. I never
had that before. My voices are always in my head."

Riley stepped over to the nightstand and picked up the beige,
single-line affair that was connected to the wall by a removable jack.
All telephones by patients' beds are arranged for easy removal in case
they're too sick to receive calls. He looked at me and suggested,
"Could a speaker have been placed inside, and the voice transmitted
from a microphone somewhere?"

On this ward they gave syringes full ofhaloperidol for that kind of
thinking. I might even have dismissed Martin's claim of hearing voices
from an instrument as being part of the characteristic delusion of
schizophrenics that messages were being beamed into them from
electronic equipment. But I'd already heard enough to know this had
been no typical auditory hallucination, and I was rapidly thinking
along the same lines as Riley.

"Maybe," I said.

"What was also odd," Martin resumed, "was that I shouldn't have had a
phone at all then." His speech sounded increasingly thick, as if his
mouth was full of glue.

"Pardon?" Riley said, looking up from his inspection of the receiver.
He'd already unscrewed the mouth- and earpiece and was checking for
added equipment.

"I'd just gotten out of isolation. No phones allowed. Yet when I got
back from my session with Dr. Forbes, the phone was there, and a few
minutes later the voice started coming from it." He stared at the
cradle portion with the touch tone dial which still rested on the
nightstand.

"But that phone was different from this one."
"Different in what way?" Riley asked, replacing one of the covers
he'd removed.

"That phone was black, and had a lot of buttons. Someone must have
changed my phone."

Riley looked up from the receiver he was working on, then resumed
reassembling it. Obviously he'd found nothing there.

"Was there anything else which struck you as out of the ordinary that
afternoon?" he asked.

"No, sir."

"What about any of the nurses? Did any of them act strangely toward
you?"

"No, not at all."

"And there was nothing about the voice that impressed you as being
different from the usual voices you hear, apart from it coming out of
the telephone this time?"

"It scared me lots more than usual. The things it said that would
happen to me--going to Hell is my worst fear."

"But you never thought someone might be deliberately trying to fool
you?"

"I was so scared. Detective. You have no idea how scary those voices
can be, and this one, like I said, frightened me more than any I'd ever
heard before." He looked down at his hands again.

"I know it seems silly now, even to me, what with my being on
medication again and knowing they're just in my head."

The torment of the disease is so great that one in five schizophrenics
chooses suicide. When Martin and others like him are out of control
and their voices rage ceaselessly at them, they sometimes live a daily
terror the likes of which no socalled normal person could ever begin to
comprehend. The thought of someone adding to Martin's already
burgeoning terror by making him fear that I was coming to kill him
sickened me.

Riley glanced in my direction.

"Can you think of anything else to ask. Doc?"
I shook my head.

"You've been most helpful," he declared, turning back to Martin.

"I appreciate how much courage you showed in revisiting very upsetting
memories, and I promise you, if any of what happened to you was
deliberate, we'll get the person or persons responsible." He then
spoke to the parents.

"I also want to thank you for taking the time and helping us with--"
"Time!" Martin interrupted.

"Detective, I do remember another thing that was odd, after all. It
was the time Dr.

Forbes was late for our session. It struck me then because he's never
late. And another thing. When I was sitting there in his office
waiting for him, his phone started ringing. It wouldn't stop. I
didn't answer it, of course, but the noise bothered me. Then when Dr.
Forbes did arrive, he didn't answer it either. Instead he just took
the receiver off the hook without speaking to whoever it was and put
the whole phone in a drawer of his desk. So we wouldn't be disturbed,
he said. I took it then as simply a thoughtful gesture--one that made
up for him keeping me waiting--and I didn't think any more of it. But
with all that talk of yours--implying how the phone might have been
used to make me hear that terrible voice--I just remembered something
about that incident. The phone he put away wasn't his usual big black
one with all the buttons.

It was a simple beige model like that," he said, pointing to the
nightstand.

"I think someone switched our phones that day."

"Forbes thinks it'll be a routine interview at seven this evening.

The time's in keeping with how we've scheduled all our other meetings
with doctors at the end of their working day so as not to interfere
with their care of patients," Riley was saying, huddled over his coffee
at a corner table in the cafeteria.

"But in this case the intervening hours will give us a chance to
interview every nurse who was on the floor the day in question, so we
can have as detailed an account of his movements
during that particular afternoon as possible. Then if the son of a
bitch starts lying to us about his actions, we'll be on to him
immediately."

"Won't he be suspicious, receiving all this attention?"

"We've simply stated that we're expanding the investigation and re
questioning people since we have no leads, so I don't think he'll
suspect we're coming after him specifically. But I'd like you with me,
so he can't snow me with psychobabble..."

It was just before noon, and since our meeting with Martin Whitehead,
the detective had spent the hours marshaling his officers to draw a
noose around Peter Forbes. We'd agreed to meet for coffee so he could
fill me in on the plan he'd arrived at, and this time I had no qualms
about helping him. The scalpel planted in the nightstand had erased
all doubt that Martin's "voice" had been fabricated to set him on me.

"... figure the black phone with all the buttons had a speaker as part
of its regular features. All he'd have to do is take it to Whitehead's
room, plug it in, dial his own extension..."

As Riley elaborated on how "voices" could be made to come out of the
phone, I was trying to figure out how the psychiatrist might have been
implicated in Saswald's murder and why he'd want me dead. In the end,
I hadn't a clue.

"... when the session was finished, he probably told Whitehead to
return to his room and rest. All he'd have to do then was take out the
phone he'd hidden in his desk-the connection would still be intact--and
start broadcasting his whispered threats and instructions to that poor,
terrified kid..."

Perhaps we could frighten the fat little prick into telling us
everything after we got him into custody and out of his four
thousand-dollar suits, I thought hopefully. After all, we had a charge
of attempted murder to threaten him with.

"I wouldn't miss being there to help you take the creep down for
anything," I assured Riley when he'd finished talking.

"And I'm particularly looking forward to seeing the misery in his face
when you slap the cuffs on him."
Riley gulped down the last of his coffee and ran off to brief Fosse
about what was happening, including the possibility that Dr. Peter
Forbes could be led out of the hospital under arrest that very
evening.

I downed what was left of my own cup--it would be all the lunch I'd get
today--and hurried back to my office, where I was scheduled to do a
phone interview on the abusive powers ofHMOs with a well-known
noon-hour talk show host.
Chapter 11

The program went well, I thought. My interviewer had a way of cutting
to the bone of the issue, and I was primed to stomp on a few toes. Even
the threat against Janet was fodder for my anger, and I threw it into
the mix.

"You've had threats made against you for speaking out against the
practices of these companies?"

"Against myself, and against my wife, Dr. Janet Graceton, which I
thought was particularly gutless."

"Are you accusing any company in particular?"

"The police will be doing that."

"Obviously they've made a mistake if they thought they could shut you
up."

"You bet they have. I believe the only response that works with people
like that is to expose them, the way you lay open a cancer and cut it
out."

"So what are you saying that's got them so upset?"

"For starters, let's talk about withheld care. Or better still, let's
debunk the jingoistic claim of these companies that they don't withhold
care but simply withhold payment. Let's discuss how doctors get
bonuses if their patients cost the HMO less than the national average
for whatever diagnostic group they fall into, and these same doctors
lose up to twenty percent of their income if they don't. And let's not
forget that hospitals also sign contracts with HMOs too. They have an
interest in getting patients out quicker and cheaper as well."
"I think we've known for years that it pays doctors and 157 hospitals
to keep visits, tests, and treatments to a minimum.

What's so different now?"

"What's different now is that measures initially intended to eliminate
unnecessary testing and to encourage optimal practices on the part of
doctors are currently used by companies to give themselves greater
leeway in improving profits and cutting costs."

"You mean the downsizing and cutbacks going on in other industries
these days?"

"No, in my mind this has evolved into something far worse. Other
industries are at least accountable for their cost saving measures."

"How do you mean?"

"If a car company takes shortcuts to save money and it leads to events
that cause injury or death, they're liable."

"And HMOs aren't?"

"You've got it. They can pressure doctors into making these savings
for them with impunity."

"That is pretty strange."

"Now let me be clear on this. I'm not saying all physicians or
hospitals yield to this pressure. And I certainly am not against
efficient or cost-effective care. What I am opposed to is the profit
motive having such a dynamic in making clinical decisions."

That set the tone. By the time we neared his signoff time at one
o'clock, we'd covered everything from the tactics of provisional
approvals for admissions and ER visits to policies for seniors which
imposed such unpalatable choices on them that they'd rather risk dying
at home.

"Before we conclude, let me ask you. Dr. Garnet: Are you claiming
these companies behave like this across the board-with all their
patients? If you are, that's a pretty sweeping indictment."

"Of course they don't. Even with the recent trend toward such methods
in Buffalo, so far I'd estimate we're only seeing examples of it in
about one out of every hundred patients."
"Let me be provocative here. Why should we be excited about something
occurring on such a small scale?"

"Because the resultant delays, even on a small scale, are exceedingly
dangerous. In my ownER over the last month a child has died and an
adult has been left seriously disabled-permanently, I'm afraid. Even
as we speak I know of an elderly lady who's risking her own death by
staying alone at home because her HMO would only provide a provisional
approval of her admission and she'd lose her house if, in the end, they
reneged on covering the expenses."

"But why would these massive companies bother to pull such stunts on
only one percent of their clients?"

"Because they probably figure they can get away with treating one
percent of their clients this way. Look at your own reaction. A
second ago you yourself asked why get excited about it."

"Good point," he conceded.

"All right. You've shown me that they can get away with it. And
you've explained how existing laws make them immune to lawsuits for any
damages resulting from their pulling these moves. What you still
haven't explained is why they bother."

I was ready for this one.

"The other day our CEO at St.

Paul's reminded me that health care is a trillion-dollar business in
this country. You discourage one in a hundred people from seeking
attention, and even if only a half of those are intimidated away from
ever getting help, the resultant half-aper cent cut in expenses would
still save these companies five billion a year. That's a lot of bonus
money for the men and women who run them."

"Thank you, Dr. Garnet."

This broadcast had the hospital muttering, loudly, all afternoon.

If my encounters with colleagues were any measure, half hated me and a
quarter of them thought I was nuts. Men and women alike gave me their
dirty looks, icy stares, and
called me asshole under their breath as they passed. It got vicious
enough that I found myself wondering whether last night's threat had
come from one of them. That notion disturbed me even more than the
thought that it might have been from some thug working for an insurance
company.

But I also had reason to take heart. The remainder of doctors who
reacted to my performance were alarmed enough by the growing impact
ofHMOs on their own practices that they stopped me in the halls and
asked what we could do about it as physicians. Apart from encouraging
them to speak out to their patients and the media as I'd done, I had no
ready solutions.

Organizing against the companies the way Jack MacGregor had in San
Francisco was an impossibility with seventy-five percent of our
physicians hostile to showing any opposition at all.

The retaliation from Brama came later that afternoon, and it was
leveled against Janet. As opposed to what we'd been expecting--goons
in the night--they resorted to a dirty trick that was absolutely
legal.

Maria Naglia, a senior secretary in their contracts department, sat
across from me at a small conference table in a seminar room near the
birthing center. She looked in her late thirties, was plump in the
midriff, especially for her short height, but had contrastingly thin
arms which seemed to dangle out from the voluminous short sleeves of
her oversized blouse. Her moon-shaped face beneath thinning dark hair
already streaked with gray completed the picture of someone who
probably suffered from Cushing's disease--a disorder leading to
diabetes, hypertension, and brittle bones.

She was obviously nervous, and kept glancing around at the nock-ups of
female reproductive anatomy that lined the shelves on the wall in front
of her. She was also a patient of Janet's.

Having decided to warn us after hearing me on the radio, she'd come to
St. Paul's on her way home from work and paged us both. Janet was
sitting at her side, a protective arm around the woman's shoulders
while listening intently.

"If they found out, I'd lose my job," the woman was saying, "yet I
couldn't stay quiet and not warn you, Dr. Graceton, especially after
all you've done for me."

A key chain lying by her purse contained a baby's picture. I assumed
Janet had gotten the woman through the rocky pregnancy that cushingoid
women normally experience.

"At Brama they keep a list of physicians designated 'the undesirables,"
doctors who repeatedly exceed their average costs per patient despite a
repeated twenty percent cut in fees.

But as you know, these doctors often are the ones who care for people
in need of expensive treatments, such as those with AIDS, geriatric
patients, or, as in the case of your practice, women like me, who are
considered high obstetrical risks. This morning I got the directive to
add your name to that list. When your current contract expires with
them at Christmas, it won't be renewed."

"What?" Janet said, incredulous.

"But those bastards came to me when they first arrived in town,
pestering me to sign a contract with them, because so many of the women
they were trying to sign up would only do so if I was one of their
approved obstetricians. If I knew then what I know now about them, I
never would have, but--" "Dr. Graceton, I don't think it's got
anything to do with you. It's your husband they're after," she said,
looking over at me.

"They can't get to him directly, so they're coming after you."

I was paid out of the hospital pool of emergency revenues.

The reduction of our incomes due to their boycott hit me as it did
everyone else, but it was limited to their ten percent of market share.
They couldn't single me out as they had Janet because my contract was
with St. Paul's.

"Have I got any options?" she asked, looking stricken.

"Or more to the point, do my patients who have policies with them have
options? How easily could they switch out of Brama to one of the
other carriers where I'm still under contract?"

"Not easily," the woman answered. Then she flushed, swallowed a few
times, and added, "I'm afraid you're facing worse problems than that.
Health care companies always deny doing this, but not only do a lot
follow the policy of listing socalled undesirables, some even exchange
these lists amongst themselves. A doctor dropped by one company as a
high biller may soon find himself or herself dropped by others and,
once stigmatized, unable to get new contracts anywhere else."

I interrupted.

"Why would competing HMOs help each other?"

"To avoid both public and political scrutiny. Acting in concert this
way, no one firm sticks out from the rest as they cut back or limit
their exposure to certain high-risk, high-cost diagnostic groups. That
means they can't be accused of discriminating against these particular
patients. And if they all dismiss doctors from time to time, some of
whom happen to be heavily involved in the care of these patients, the
practice is less likely to attract attention to any specific company
and more likely to appear as if it's simply part of employers'
exercising their right to sign, renew, or let drop any contract they
please. Since the collusion occurs at the level of CEOs and
presidents, it's next to impossible to prove. Names arrive the way Dr.
Graceton's did, and we let contracts drop. Even if I wanted to blow
the whistle, which I don't, I couldn't prove anything. Hell, I'm not
even sure the whole business is illegal, and perhaps they're keeping it
secret simply because it's so odious. After all, if it ever became
public that HMOs were using a loophole in their contracts with doctors
to systematically exclude from care some of the sick est patients in
the land, there'd probably be such a furor we'd get some new
regulations damn quick that would put an end to their little game."
Turning to me, she added, "Congress might even be forced to throw in
some of those right-to-sue laws you've been talking about. Which
brings me to my point." She returned her attention to Janet.

"I don't know any easy way to say this, so I'll come right out with it.
All the CEOs and presidents of health care companies in these parts are
so mad at your husband, I'm afraid you can soon expect to become an
undesirable across the board and have your contract dropped by all the
other outfits in town."

"Those bastards!" Janet ranted, pacing circles around my small office.
We'd retreated there after Maria had left.

"Those filthy, rotten bastards."

"Easy, Janet. We'll fight it."

She swung around to glare at me, her eyes like blue fire.

"Don't you patronize me. You know damn well there's not a thing I can
do. No doctor can once this happens."

She was right. Under existing rules, no company was obliged to give
just cause for dropping a doctor's contract, and since it was simply a
yearly agreement renewable at the company's discretion, physicians had
no recourse to claiming unlawful dismissal. And as Maria Naglia had
indicated, neither could patients do anything, at least not right away,
without paying a stiff financial penalty. Since most of them wouldn't
have the financial means to change carriers in protest, they'd have to
accept one of the many remaining doctors in the Brama plan, until their
own policy came due for renewal, possibly years from now. Besides, if
the companies acted in concert the way Maria suggested they could,
there wouldn't be any carrier they could switch to and still retain
Janet's services. No matter what we did, she'd be out of business, all
because some CEOs wanted to shut me up and close me down.

I walked over and put my arms around her. She was trembling.

"I'm sorry, Janet, so awfully sorry," I whispered to her, feeling my
rage mount by the second.

"But I swear, I'll find a way out of this."
As I held her, the cuff of my sleeve slid up my wrist, exposing my
watch. It was 5:05, and I realized I'd already missed an hour of the
board meeting.

A few minutes later I was in the wood-paneled domain of Administration
and scuttling over inch-thick blue carpets.

The secretaries and almost everybody else had gone home for the day, so
as I hurried past the empty reception areas I could look into the open
doors of all the plush office suites that were apparently necessary to
run St. Paul's these days. To be fair, I'd never yet seen any
hospital where this part of the operation wasn't first-class all the
way, whatever their budget problems.

I had few illusions about the reception I'd get from the members of the
body I was rushing to meet. They were primarily Buffalo's corporate
elite, mostly men, some women, and CEOs all--a group too comfortable
with the language of profit and loss for my liking, and they brought it
so easily to the ongoing debate of how to keep St. Paul's abreast of
current clinical trends, procedures, and equipment. All too often the
first question they'd ask was, "Can we afford to keep up with what is
best for the sick?" or, as I was starting to bear lately, "Can we
legally get away with providing the minimum?"

Pushing through the ceiling-high oak doors to the boardroom, I came
upon an even richer decor of rosewood-paneled walls, pastel green
broadloom, and a mahogany table that could seat twenty at a side.

Fosse was chairing the meeting from the far end of the room, and his
audience at the table mostly had their backs to me, having swiveled
their chairs in his direction. I slipped into an empty place behind
everyone else.

The discussion appeared lively, and it didn't take me long to figure
out what the topic was.

"... a disgrace to the hospital!" shouted a grandmotherly looking
woman three places from me.
"... admissions down ten percent with eighty beds now empty!" howled
a jowly middle-aged man who I remembered once treating in ER for
gout.

"... the gall of the man, using the media to stir up even more trouble.
I got calls today from every HMO we have a contract with, and if even
half of them make good on their threats to drop us--" Fosse slammed
down his gavel and brought the cacophony to a close.

"I won't have you maligning one of our finest physicians that way!" he
declared, his black eyes flashing defiantly as he cast a stern gaze
around the room. But when he caught sight of me, I saw him start.

At first his declaration was met with silence. Within seconds the
quiet was broken with groans and murmurs of disapproval.

Then came angry mutterings, and finally, halfway up my side of the
table, a small man with a huge mane of white hair jumped to his feet,
waving his finger in the air, and shouted, "I move we demand Garnet's
resignation!"

The rest loudly seconded the idea.

"... no other choice but to get rid of him..."

"... his continued presence means a loss in revenues we can't sustain.
We'll have to close the beds and lay off staff..."

Fosse hadn't moved his eyes away from me. His gaze seemed to grow
sadder and his frown deepened with each angry comment. A few other
people turned my way, presumably to see what he was looking at. Soon
they were nudging their more vocal neighbors and nodding toward my part
of the table. In no time all the noise had died down and every eye in
the place was on me.

In my white coat amidst all the dark suits, I felt like the last chess
piece of a very one-sided game.

Fosse jumped to his feet and roared, "I'm disgusted with all of you!"
His face grew flushed above his white beard, mimicking the colors of a
beef on rye.

"I'll have you know Dr. Garnet's stand against Brama and the other
HMOs has struck a nerve in this community. You say you got calls from
these companies? Well I've been inundated with calls of support for
the man from our patients--the real lifeblood of this hospital. They're
fed up with the likes of Brama jerking them around, maximizing profit
by minimizing care, and crossing ever farther beyond the bounds of
decency in doing so. Dr. Garnet's a credit to this hospital as far as
they are concerned, for giving a voice to their frustration, and you
want him fired?

You'd sacrifice one of our best to protect companies that represent
what's worst in our business?"

Fosse caught his breath and surveyed the well-heeled group. A few
looked away as he tried to catch their eye. He leaned forward, placing
his palms on the table.

"Look at me, all of you!" he ordered, his voice suddenly quiet. His
abrupt drop in volume seemed to electrify his audience into listening
more attentively. There wasn't a shuffle, a cough, or a whisper of
disapproval to be heard.

"Have you forgotten what happened to the little boy whose case
precipitated all this? Do you even remember his name? I do. It was
Robert Delany."

Nearly everyone in the room winced.

"Do you want your child treated like that?" Fosse pressed.

"Perhaps you'd like the parents of that boy brought in here so they can
witness which side of this fight you want the hospital to take?"

I saw the white-haired man who'd called for my resignation start to
fidget with his hands. A few of the others who'd been his noisy
supporters made little clearing sounds in their throats. They all kept
their eyes on the table.

Fosse took stock of the impact he was having on his audience.

"Yes, it's harder when we make it personal," he continued, speaking
almost softly.

"But I think it's our duty to keep issues like this personal. I've
fought against the type of mentality that killed Robert Delany my whole
career because I learned at a very young age what it's like to lose
someone needlessly for want of access to good doctors. And at the end
of a forty-year career in health care, I can say that there are few
enough Earl Garnets around to keep the light on in ER for anyone who
needs help."

He straightened, walked around to where I was sitting-the rest of the
room absolutely still--and insisted on shaking my hand. Smiling down
at me, he spoke over his shoulder.

"There are at least a dozen of you who this man has treated personally
at one time or another. I know, because you called me first to set it
up. If you've a shred of self-respect, you will stand by him now, and
protect him and his work from the travesty of Brama trying to silence
him!" Turning back to face the table, he added.

"As for any of you who still want to fire him..."

He walked over to a wastepaper basket and gave it a fierce kick,
sending it clattering down the room. Gasps of disbelief filled the
air, and those sitting nearest the missile leaped halfway out of their
chairs. Even when it spun harmlessly to a stop on the carpet, jaws
continued dropping to the right and left of me.

Fosse stood there with his hands on his hips and let the reaction to
his outburst die down.

"I'm in my retirement year, folks," he said, still ever so quietly.

"That means I've got nothing to lose in any battle you want to wage
here, and believe me, I'll do whatever it takes to keep this hospital
from knuckling under to the likes of people who think that what
happened to little Robert Delany is an acceptable business practice."
As he spoke he met the stare of anyone at the table who dared look at
him, and in those seconds he actually seemed menacing, which was
completely at odds with his stout Kris Kringle appearance.

"Come on. Earl," he ordered, once he'd cowed every set of eyes in the
room.

"I'm sure you've got far better things to do than waste your time with
this sorry lot."

No sooner were we outside the massive oak doors than he warned, "I can
talk tough, but I don't know how long I can stall those creeps back
there from dismissing you as chief.
I'm sure you're aware there's a lot more than your job at stake here.
If Buffalo's leading teaching hospital caves in to the HMOs calling the
tune about which doctors can work and who will provide our medical
leadership--" "You're damn right I'm aware," I interrupted, having
already decided that I'd found an ally to help with Janet, "and I
suggest we go to your office to discuss how you and I are going to
protect the latest physician to be targeted."

"Threats?

"Undesirables'? Putting a doctor like Janet Graceton out of business?
It's a nicking outrage!" Fosse ranted while he paced a groove in his
own taupe-colored broadloom.

"I knew we were headed into this kind of crap, but it's twice as
disgusting when it actually happens." Each time he pivoted to change
direction, I thought he might leave divots in what was clearly the
thickest carpet in the hospital.

"You know what we're gonna do?" he challenged, spinning around and
pointing at me.

"Tomorrow morning you and I will pay the president ofBrama a visit. The
son of a bitch is here from the West Coast visiting the local offices.
I'll set the meeting up, implying I'm coming in to discuss terms for
ending the boycott, then we'll surprise him with the two of us and
confront the hell out of him about what he's doing to Janet. Will she
want to come as well? I've never seen anyone fiercer when it comes to
fighting on behalf of her patients."

"Probably she will. I'll ask her tonight." I noticed he hadn't
mentioned the occasion on which he'd learned Baines was in town. His
apparent decision to keep his own counsel in matters regarding David
Pearson reinforced my determination to do the same in front of Riley

He started pacing again.

"You know what might really scare them?" he said, waving his right
index finger in the air.

"What if we went to the media about them declaring doctors as
'undesirables'?

Would Janet accept making her own case public? Of course I'd tie it in
with attempts to silence you over the Robert Delany case, and I'd make
the boycott against the hospital public as well. What d'ya think? Go
on the offensive?"
I was staggered.

"I... I like it," I finally stammered, then quickly added, "Of course,
I'll have to run it by Janet."

"My bet is she'll go for it like the tigress she is," he declared, his
eyes sparkling with excitement.

"You've no idea, Garnet, how much it would mean to me to take that
bloodsucking Brama down a rung or two before I retire. I meant what I
said at the meeting. It drives me mad to see everything I've stood for
come under such a sustained attack just as I'm about to head out the
door..."

As he ranted he was striding up and down in front of a mahogany-paneled
wall covered with photos that documented highlights from the lifetime
of work he was alluding to. Most were pictures of him receiving
oversized checks from private donors to finance special medical
projects, but a few were of him in groups from years gone
by--graduating classes, his military outfit, old sports teams--and off
to the side of this gallery were some shots that looked more like
family photos.

"... convinced Brama's the key. They're the scourge of the profession.
If we can make their sleazy practices into such an expensive public
relations disaster that the bastards back off, there's an outside
chance that the other goddamned companies will fall into line ..."

His face had reddened again, and his dark eyes glinted as fiercely as
they had in the boardroom, but what struck me most as I stood at close
quarters to him was the force with which he kept slamming his right
fist into his left palm. The man was in a frenzy.

"... and that leech Baines is sure to be more than a little spooked by
the investigation into Saswald's murder, which won't hurt us any,
because he'll be worried about the bad PR on that front as well.
Detective Riley briefed me about how jumpy the asshole gets each time
the police show up to ask questions.

Frankly, it warms my heart, the thought of him being scared shitless
whenever he's interrogated by the law--" "Mr. Fosse," I interrupted,
bringing him to a standstill, "I simply want to say how ... how ...
well, proud I am to be fighting alongside you on this. I don't know
quite how to put it, but I never met an administrator like you before,
and, well, you're very special. Thank you."

He stood looking at me, his cheeks growing flushed, his eyes watery. He
abruptly turned away, ending up facing his wall of photos. He appeared
to study them as he presumably composed himself. When he did speak, I
had to strain to hear him.

"As with all crusades, mine started with an old hurt.

Maybe when you've time to listen, and I'm not quite so emotional, I'll
tell you about it." He glanced down at the family end of the display,
but said nothing more. When he did look me in the eye again, his color
had returned to normal and a smoldering blackness had replaced any
trace of tears.

"I'm going to let you in on a secret, and you mustn't breathe a word of
it, not even to Janet. If all goes according to plan, I've got a new
weapon that will help us against Brama."

As I stood there and watched, a sly grin spread under his beard and
mustache. When it reached the size of a smile, he glanced toward the
closed door of his office, then whispered conspiratorially, "I'm on the
verge of bringing in the largest endowment of my career, and it's
fitting that you be the first to know." He'd lowered his voice even
further, despite our being alone.

"The benefactor wishes to remain anonymous, but it's going to be called
the Robert Delany Fund, because the impetus for its creation was when
you made that poor child's case public. Its sole purpose will be to
combat exactly what we're talking about--the abusive policies by HMOs
of the kind that led to that toddler's death."

This retiree-to-be was single-handedly adding a whole new dimension to
my understanding of medical politics.

"But why didn't you tell the board that?" I demanded when I got over
my astonishment.

"Surely that would have calmed them down."

"Are you kidding!" he exploded, slamming his fist into his palm again
and starting to pace once more.

"Because it's possibly going to take months to set up. And for it to
work, if and when I do get the money, I have to spring it on Brama by
surprise.

We certainly can't count on our having it operating in time to get both
you and Janet out from under the immediate threats to your jobs."

"But how would you use the fund when it is ready?"

A sparkle danced back into those coal-like eyes.

"As I told you, we have to nail that particular company hard--hurt
them--for pulling the crap they do, and make it a message all the other
companies will understand. If a patient gets the nm around from them
about emergency care, the fund will not only initially pay that
patient's ER expenses, but will also finance a very public, very messy
campaign to make the sons of bitches settle the account. Radio, TV,
newspapers, billboards--every means of negative advertising possible
about their every indiscretion will be brought to bear on them. Now
that's the kind of pressure that could actually put them under and win
us this war. Of course you can see right away another reason why I
couldn't tell the board about it. No one in that bunch has the stomach
for what's called for here, and most of them would try and stop me. I
have to get everything in place and launch a campaign that's so quick
and dirty they won't be able to do anything about it."

I found myself smiling.

"Once more, Mr. Fosse, let me tell you that I like how you think."

"Really?" he said with yet another grin, this one quite sly.

"Well let me introduce you to my teacher." He walked toward the
section of the wall dedicated to what I thought were family portraits
and stopped beside a faded, sepia-tinted, black and white photo of an
old man standing with a young boy.

I leaned forward to look at it. The man, dressed in a safari jacket
and puttees, was lean, and beside the boy, at least, appeared to be
quite tall. He wore a handlebar mustache, had very hollow cheeks, but
his eyes were the most arresting.

They were dark, deep-set, and even in their faded rendition seemed to
sear right into me. The boy looked about five, was holding up a
medium-sized fish, and was smiling a little grin that looked half shy,
half proud.

"That's me and my grandfather," Fosse explained from behind me, "taken
sixty years ago. He was the black sheep of the family, a gangster from
Chicago's East Side, though he was always very kind to me. It was only
when I was a teenager and he was 'retired' that he began telling me
about what he did, and even then it was in bits and pieces, exciting
stuff about fights and guns that he knew would impress a boy who wasn't
quite yet a man. When I got older, I put those pieces together enough
to figure out that he was an enforcer for the protection rackets, and a
pretty small-time one at that.

Years later when I was an adult and he was frail and elderly, he'd
sometimes talk frankly with me about the 'old days."

Once, I asked him about the violence and bloodshed of his business. He
didn't make any apologies about what he'd done, but rather, told me how
he'd kept it minimal.

"If you hit the leader hard and send a very clear message, everyone
else pretty well starts to behave and you have no more trouble, for a
while. But if you're half-assed about it, and the message isn't strong
enough, the bloodletting goes on forever." That's what you and I are
going to do to Brama, Earl, using billboards and media coverage."

I shared a wicked chuckle with him, then glanced at my watch. It was
six-ten, and I was due to meet Riley in my office for a final
debriefing before we went to confront Peter Forbes at seven.

"I'm sorry, Mr. Fosse, but I have a meeting scheduled in ER for a few
minutes from now."

A cloud passed over Fosse's face. He said nothing, but after Riley's
debriefing earlier, I figured he knew the grim business that I was off
to do. We arranged a time to meet in the morning, shook hands, and I
left. As I strode along between the lines of deserted offices, I
wondered about what had happened "at an early age" to have instilled in
Fosse such a magnificent, lifelong passion to stand up for the sick.
* * * Riley arrived at barely five minutes before seven.

"Sorry," he quickly exclaimed, "but my debriefing with the officers who
questioned everyone on Whitehead's floor took much longer than I'd
expected. Let's head up, and we can talk as we go."

The start of visiting hours meant large groups of people were waiting
at the elevators, and we took the stairs instead.

Though Riley appeared heavier and older than me, his conditioning was
obviously superior. He talked easily as he took the steps two at a
time, whereas I was left puffing heavily just trying to keep up.

"We got all kinds of nasty little circumstantial tidbits against
Forbes," he began.

"First, the nurses remembered that he'd given them specific orders to
bring Whitehead's three o'clock meds to his office, where he'd
scheduled their session together. He told them he wanted to give the
meds himself only at the end of the interview, in case he decided to
change Martin's drug regime after evaluating his progress. After the
meeting was over, Whitehead was told to rest in his room. The nurses
recalled that Forbes left strict instructions not to disturb Martin,
since he'd upped his sedation.

What they found unusual, but not unheard of, was that Forbes said they
were not even to take him his supper, but instead to let him sleep
until morning. Now you tell me, doesn't that all fit with Forbes
giving himself the opportunity to slip his patient the glyburide pill
and then work on him with the whispered messages?"

"I guess so," I gasped as we rounded the first floor landing and headed
toward the second.

"I figure it also increased the chances of the nurses not noticing that
their patient had slipped off the ward when he headed down toER. But
here's the clincher. Forbes is connected to Brama."

"What!" My surprise nearly made me pull up, but Riley never broke
stride.
"One of my men conducting interviews on the floor today caught sight
of him and remembered seeing the man going into Baines's office on the
Tuesday after Saswald's murder."

"How the hell did he remember that?" I managed to wheeze. We were
nearly up to the third floor.

"He'd come looking for me, except I'd already left, having finished
questioning Baines and his CEO a half hour earlier.

But while he was there he noticed this ugly fat man in a super looking
suit striding in to meet with Baines. At the time he didn't know who
the guy was, but he remembers commenting to his partner about it, that
expensive clothes could make even a toad appear handsome. When he saw
Forbes upstairs today, he recognized him right away."

Riley was already on the fourth floor landing and holding open the door
into the administrative wing of Psychiatry.

"Think of me sequence," he was saying as I caught up with him.

"Saswald's murdered Monday evening. My officers spend the night and
all day Tuesday asking about the name "Pearson," and that afternoon I'm
making Baines and his CEO squirm with questions about their Mexican
addiction clinic.

Then Forbes is seen trotting into Baines's office, and the next evening
Martin Whitehead is manipulated into trying to kill you. Let me tell
you, I'm really looking forward to hearing what this son of a bitch has
to say about all that!" Riley's voice had dropped to a whisper as we
stepped into the corridor and strode toward Forbes's office. He didn't
hesitate when we got there, but stepped up and knocked firmly.

No answer.

He looked at me, lines of concern suddenly zigzagging across his
forehead. He repeated the knock, and when there was no reply, he tried
the handle. The door was locked.

"Shit!" he muttered.

"I've got men at all the exits from this floor, in case he made a run
for it, but if he's bolted the hospital, then we've got our work cut
out for us." He started to run in the direction of the patients' wing
where the nurses' station was located, then stopped in mid-stride,
puzzlement replacing the concern on his face as he looked down at his
feet.

"What the hell?"

I'd felt something sticky pull at the bottom of my own shoes as I'd
taken a step to follow him, causing me to also glance down.

My gut clenched like a fist.

Fresh blood was oozing out the bottom of the door and beginning to
puddle where we'd been standing.

"Jesus Christ!" Riley exclaimed, leaping forward and hammering on the
door again, this time twice as loudly.

"Forbes!

Open this door! Can you hear me?"

Silence.

"Shit! Run get a key!" he ordered, and began to throw his shoulder
against it. From the solid thudding noise that echoed along the hall
each time he made contact with the heavy wood, it sounded as if he
might as well be attempting to batter down the tree that it had been
cut from.

I ran up the deserted corridor, heading for the door leading through to
where the patients were. I flung it open and began yelling, "Help!" as
I continued my sprint toward the station.

"I need a pass key for Forbes's office!"

The ruckus caused a few patients to stick their heads out of the
entrances to their rooms. A pair of nurses also appeared, coming out
of a doorway just ahead, where they'd presumably been attending to
someone. Farther on, their supervisor stood and glowered at me from
behind the counter surrounding the ward's central workstation.

"Someone's locked in Forbes's office and is hemorrhaging," I exclaimed
as quietly as I could when I drew near the two nurses who'd stepped
into the hall.

"Get security up here fast with a key," I directed the one standing
closest. To her companion, I ordered, "You keep the patients in their
rooms."

They hesitated as a look of shock passed over both their faces. One of
them appeared about to speak.

"Move!" I yelled, cutting her off.
They blanched but sprang into action. The first woman stepped back
into the room she'd come out of and grabbed the bedside phone.

"Locating, this is an emergency..."

The other one strode down the hall, ordering, "Okay, you people, back
out of the hallway! I want this area cleared..."

I shouted to the still-frowning woman at the counter, "Call a Code Blue
for Forbes's office, stat!" I spotted a nearby utility cart, from
which I grabbed some latex gloves and masks.

Whatever we found, it was bound to be messy and wet.

Pulling on the protective wear as I raced back into the administrative
wing, I heard the thudding up ahead suddenly end in a splintering
sound, and Riley yelled, "I'm in!" But as I ran up to him, I saw he
was having trouble pushing the door open more than a few inches, and
already more blood was flowing over the sill and spreading on the
linoleum floor around his feet. The office itself was in darkness. He
shoved harder, making the gap wide enough so he could squeeze through.
Disappearing inside, he switched on the lights.

"Oh my God!" I heard him exclaim.

Even with my mask on I could scent the sickly metallic odor. Breathing
through my mouth, I quickly followed him inside, my shoes squishing
over the soaked carpet. As I peeked behind the door I saw Peter Forbes
lying on his back, his head pointed to where I was standing, his right
arm stretched up to the door handle, fingers still encircling the knob.
His neck was slashed open, a deep clean cut identical to Saswald's, but
where that laceration had nearly drained empty, this wound was still
awash in blood, the vessels and structures within obscured from sight.
A trail of red showed where he'd dragged himself from one of his
overstuffed antique chairs--now coated in glistening crimson atop the
maroon and gold. Everything else--his desk, the bookshelves, his
journals, even the ceiling--had been caught in the spray.

Riley was kneeling beside him.

"Mother of God, Doc, look!"

He was pointing to where small bubbles were forming on the surface of
the yet-un clotted pool welling out of the trench like gash. I
quickly stooped down beside him and stared.

Amidst the dark, more static portions of the liquid, I could still see
tiny pumping eddies of brighter colored currents swirling up from
below. His heart was still beating.

"He's alive!" I cried, more out of horror that he could survive in
such a state than as a clinical pronouncement.

Then, as if to confirm what we were seeing, a soft gurgling sound came
out of his neck, his eyes slowly slid half open, and ever so slightly
his mouth began moving, making the shapes of noiseless words.
Chapter 12

My stomach lurched toward the back of my mouth.

"What's he trying to say?" Riley demanded.

"I have no idea!" Even if Forbes could have issued sounds, he would
have been so delirious from blood loss that he'd have emitted little
more than gibberish anyway. His half opened eyes already were so fixed
and lifeless that I doubted he could even see. But maybe he could
still hear. As someone dies, it's the auditory sense that's the last
to shut down. I leaned over him, positioning my mouth near his ear,
and grabbed his hand that was nearest me.

"Peter, it's Earl Garnet.

If you can, squeeze my fingers."

No response. Perhaps he was too weak for even so minor a task.

"Close your eyes, Peter! Close, then open them."

At first nothing happened. Seconds later, ever so slowly, as if they
were encased in glue, his lids lowered, and after what seemed an
interminable pause, opened again.

Riley immediately took over.

"Blink once if you know who did this..."

From the hallway behind me I could hear the approaching steps and
voices of the trauma team. But I was transfixed by Riley trying to
communicate with Forbes.

"Blink again if the person who did this is named Pearson...."

My breathing slowed to a stop as I stared at those sightless eyes and
waited for a response. Images of David over the years--his face livid
and swollen by drink as he'd lashed out 178 at me--flickered through
my mind with the speed of a lightning flash. Could he have returned
from Mexico in one of his alcoholic rages, this time blaming Forbes?
But for what?

Sending him to a clinic that had failed to help him stop drinking? Or
for something worse?

"Blink, damn it!" Riley implored him.

But the psychiatrist's lids remained immobile and his lips no longer
stirred. Instead his mouth hung slack, and he appeared to be giving a
departing moan.

First through the door was Sean Carrington.

"Holy shit!"

he exclaimed. Behind him came Susanne, her nurses, and Michael
Popovitch.

"Christ almighty!"

"My God!"

After them followed half a dozen residents from ER.

"Gloves everybody!" I ordered, my clinical reflexes taking over.

"He's still got a heartbeat." In the credo of a trauma center, that
meant he also had a chance, albeit a slim one.

We got to work.

As everyone scrambled to start IVs, I shoved a big wad of sterile gauze
into the depths of his wound. The white material instantly turned
crimson, soaking up enough blood that the sides of the trench-shaped
cut became visible. Amidst the remaining wetness I could see torn
strands of muscle and the open ends of lacerated vessels pouting from
the lower half of his neck--but not the severed airway I was looking
for. Using more swabs, I got the area sufficiently dry that I could
make out the lighter-colored interior of two other orifices. One, I
knew, would be the creamy lining ofatransected esophagus, and the other
had to be a cartilage ring in the open end of his trachea--the object
of my search. But the openings were so recessed in the surrounding
tissues, and the anatomy of the neck was so distorted that I couldn't
tell for certain which was which.

"Tube them both," Sean muttered, peering into the twisted mess from his
vantage opposite me. He reached and slipped the tip of an
endotracheal airway into one of the two lumens.

While he secured it in place I performed the same procedure on the
other opening. We took turns giving the chatter of teaching,
explaining what we were doing as the residents hovered over us.

"... a few puffs of air with the ventilating bag will tell us which is
the trachea..."

"... if you hear gurgling, you're in the stomach..."

Soon we were sending volleys of oxygen into Forbes's lungs and letting
the remnants of his most recent meal drain into a basin.

"Probably his last," I heard someone mutter.

Glancing behind me, I could see that Michael and Susanne had infusions
of normal saline up and running through large bore lines in his
groin.

"To the OR," Sean ordered quietly.

Lifting Forbes onto a stretcher, we raced for the elevator, Sean
bagging him through his open neck, me supporting his head against its
sickening, lolling motion, and a nurse holding his intravenous bags
aloft while riding on top, her knees astride his legs. Despite
repeated shouts of "Stand clear!" our macabre little float was
constantly slowed by the parade of visitors arriving at that hour. In
our wake I could hear a steady stream of stifled screams and loud
gasps.

At the operating room more nurses, technicians, and residents--all
shouting orders--swarmed our near-lifeless cargo. They drew bloods,
started 0-negative transfusions, and inserted additional lines, then
wired him to so many monitors that an entire wall lit up with screens
displaying digital readouts and luminescent tracings. A masked
anesthetist took command of his breathing and quipped, "Quite an
airway," saluting Sean and me with a pair of raised eyebrows.

A pair of nurses finished cutting away his finery, leaving him naked,
with his white belly dominating his skinny limbs.

Others went to work between his legs, skewering his limp manhood with a
thin red catheter. If past rumors were true, more than one of the
women present had had intimate encounters with that part of him
before.

Pulling on sterile garb, I watched Sean--already masked, gowned, and
regloved--as he picked up a scalpel, anointed the left side of Forbes
chest with a swab of disinfectant, and made a sweeping incision along
his sixth rib. Into this opening he inserted a pair of hinged metal
claws which he used to pry the ribs apart. With a few popping sounds
the moist connecting cartilage gave enough that a half-foot-long gap
several inches wide appeared in the chest wall. It was big enough to
admit a hand, and I reached inside. The shiny wet surface of healthy
pink lung tissue bulged out around my wrist with each inflation by the
anesthetist.

"Whatever other habits he indulged in, he was not a smoker," Sean
commented wryly as he turned to begin repairing the severed neck
vessels.

I slithered my hand past the expanding and deflating lobes until I felt
my fingers close around his barely beating heart.

Gently I began compressing and releasing the ball of muscle at a rate
of once a second to augment its feeble pumping action.

But my thoughts were neither caring nor professional. How could they
be--the man whose life I had in my grasp had tried to kill me. For his
willingness to sacrifice Martin Whitehead in the process, I loathed
him, and I was growing more convinced by the minute that he'd also
wronged David, knowingly sending him to a facility with such terrible
secrets as to require murder to keep them hidden. While every squeeze
of my fist determined his chances of survival, Forbes's malevolence so
revolted me, I fantasized that what he really deserved was my ripping
the organ from his innards.

By any ethical standard, my frame of mind should have compelled me to
request another physician take my place, but I didn't. Because what
overrode my detesting him was my desire to keep him alive in order that
he could provide some answers.
Given who was available in that room, I knew my own resuscitation
skills--among the best in the hospital--were his only hope. You won't
get away from me, you bastard, I kept telling myself, continuing to
pump. You're going to talk to me before you die.

The surgeons moved back from his neck to observe their work and scan
for leaks in the vessels they'd rejoined. The still-un sutured portion
of the slash gaped at me, seeming to leer at my resolve. Forbes so
resembled a corpse on a slab that the resident behind me murmured,
"This isn't surgery; it's an autopsy."

Twenty minutes later his heart simply went still in my palm. Neither
repeated countershocks nor injections of epinephrine and atropine could
start it again. The myocardium, or heart muscle, was irreversibly
damaged by lack of oxygen due to his loss of blood.

Calling off a resuscitation is always an admission of defeat, but it
had never felt like this. Walking out of the OR, furious at my having
let him slip away, I had none of my usual pity or sorrow for the dead.
Instead my raging at Forbes for what he'd done went on unabated, and
the questions left unanswered by his dying continued to pepper my
brain. Who was his killer? David Pearson? But was he also his
victim?

Ripping off my surgical mask, I strode past rows of mostly darkened
operating suites and felt the fatigue of the last few hours settling
heavily in my back, in my legs, and in my soul.

Riley and Fosse were waiting just outside a pair of swinging doors that
bore the sign caps, gowns, and boots must be

WORN PAST THIS POINT.

Fosse looked pained as he said, "For the sake of hospital security,
Earl, I don't think we can avoid any longer letting Detective Riley
look at the chart of one patient. You know whose I mean. A judge is
already being asked to grant the necessary subpoena, and for that
single file, given what's happened, there's a chance this time that the
ruling will be in favor of the police. Now, I've already alerted the
family as to what's about to happen, and suggested they get legal
representation, to protect this patient's interest, even in his
absence..."

Fosse's words faded into the background as I beheld the withering
expression in Riley's eyes. He didn't say a word.

He didn't have to. His searing stare cut into me like a blowtorch and
was more man-enough to reignite my guilt. If only you 'd confided in
me earlier, his black gaze seemed to accuse, maybe Forbes would still
be alive.
Chapter 15

Half an hour later I got a call that made all the legal wrangling
unnecessary.

I'd returned to Forbes's office at Riley's insistence, and was standing
in the hallway outside, where a group of his officers were
reconstructing how the murder had occurred. Despite Riley being
furious with me, he'd wanted me to observe the proceedings, "In case
something important might catch your attention," he curtly informed me.
When I heard my name coming over the P. A." I excused myself and
picked up a nearby wall phone.

"Mother reached me here at the base right after Mr. Fosse spoke to
her," Alien Pearson blurted as soon as I identified myself. His speech
was pressured and his voice rose to a higher pitch than what I'd heard
a few days ago in my office.

"I appreciate his advice about counsel, but we sure as hell don't need
lawyers. They'd only delay things. I figure that since the police
will be investigating my father's whereabouts anyway, why not tell them
about his being at the clinic in Mexico. Maybe then they'd get after
the authorities down there to finally mount a proper search for him--"
"Jesus, Alien, cool it!" I hissed at him, speaking behind my hand into
the mouthpiece and hunching over the receiver.

Riley was near enough that he might overhear my end of the
conversation.

"What the hell's the matter with you? You could incriminate your
father in this murder more than he already is if you're not careful. Even if he's got nothing to do with
it--" "If? Come on. Dr. Garnet. My father may be a drunk, but I
know he's certainly not a killer. Suppose by some miracle he hasn't
boozed himself to death and they do find him. Surely it'll be a simple
matter to clear him of these killings since he was thousands of miles
away at the time. Besides, in a high profile murder case like this
one, if I don't volunteer the information, there's bound to be a frenzy
of publicity about the police department suing for access to his
psychiatric file.

That would be devastating for my mother and sister--" "Alien, listen to
me!" I interrupted.

"Don't you realize that at the time of the killings he may have already
been back in Buffalo--that he could be in the city as we speak? It's
that possibility the police are going to be looking at, and lord knows
what kind of motive--" "And my father not contact me or my sister and
mother?"

he interjected.

"No way. He'd have had to be reasonably sober to make the trip, and
then we would have heard from him. He loves us. Dr. Garnet, whatever
mess he made of his and our lives--that one truth is constant--and he
would have phoned us if he could."

Not if his alibi required you and everyone else to think that he was
still in Mexico, I very nearly retorted. I found the young man's faith
in his father's innocence strangely naive, and at odds with the
cynicism I'd heard in nearly everything else he said about David.

But the headstrong Marine was giving me no more time to argue.

"Look, I'm meeting with the police tonight" he declared, "whether you
approve or not, but if you could be there with me, I'd appreciate the
moral support." Before I could protest further, he hung up.

"Damn," I muttered, as puzzled by his rashness as I was troubled by it.
Replacing the receiver, I passed under a curious glance from Riley as
I rejoined his investigators. Focusing exclusively on a young woman
in uniform who was reading from a pad, I tried to ignore him.

"... probably the killer was waiting in the dark for his target to
enter the room. From behind this door he could have grabbed the
psychiatrist, sliced his throat with a single stroke, then kicked the
door closed while keeping hold of the still-flailing victim. This
administrative wing is usually deserted by seven p.m." so there wasn't
much chance he'd be seen..."

As she spoke, despite myself, I pictured David carrying out the savage
execution she was describing, and a swirl of nausea reeled through my
head.

"... we found the imprint of a rubber boot on the carpet, suggesting
again that this killer wears protective gear against the spatter..."

My mind's eye couldn't help but visualize David drenched in blood as he
clasped the dying psychiatrist to him, restraining the man's bucking
and lashing until the death throws subsided.

But David was also a victim, I argued to myself, if Forbes had first
done to him anything nearly as evil as what he'd done to Martin. Not
that I was suddenly condoning vigilante justice--a lifetime in ER
trying to patch together the human remnants resulting from that kind of
rage had left me permanently sickened by it. But I was more ambivalent
than ever about helping the police track David down.

The policewoman pocketed her notes, reached through the strands of
yellow tape designating the murder scene, and shoved open the door to
the office, which, fortunately for us, she'd kept closed until this
point in her report. I hung back as the others looked in--I had seen
all I'd wanted of the place the first time. But I couldn't escape the
smell. It wafted from the room, filled my nostrils, then caught in my
throat.

Exsanguinated blood first congeals, then, as does any other body tissue
once it's dead, begins to decay. But the breakdown of semifluid clots
gives off a smell quicker than more solid organic matter. The process
had already started in that confined space, releasing bit by bit a
cloying sweetness into the air and adding it to the biting, sour scent
of the iron in plasma that was already so evident.

"... once the victim was too weak to crawl any distance or to help
himself, the killer-left, locking this door behind him with the
victim's keys. We think he slipped in and out unnoticed by using the
rear staircase..."

Christ, I thought, breathing through my mouth and barely managing to
keep the odor tolerable, Riley and I might have run into him if we'd
come looking for Forbes ten minutes earlier.

When the call for the detective finally came through, he scowled at the
interruption as he strode over to use the same phone that I had. While
he spoke, his gaze abruptly swung over to me, and the jaw he'd been
clenching so tightly dropped open.

After hanging up, he motioned me aside and whispered, "As you probably
already know, that was a Sergeant Alien Pearson of the U.S. Marines.
He's meeting me in Fosse's office half an hour from now to tell me
everything I want to know about his father, a Dr. David Pearson, who
was your patient.

He assured me that I wouldn't need a lot of legal rigmarole, but he
requested you be there. How about it?"

"Of course," I replied, feeling sick at heart and fearing that we were
about to do David great harm.

Alien, in uniform, sat erect on the front edge of a wingback chair as
if he were at attention. He'd taken less than fifteen minutes to
relate his father's story to Riley--telling him all about David's
addiction, his admission to the Brama clinic in Mexico, and his
subsequent disappearance.

Riley occupied a small sofa a few yards from Alien, and occasionally
jotted notes on a pad as he listened. Two of his officers stood
lounging against the wall behind their boss, and Fosse was perched on
the corner of his oversized desk, watching the proceedings attentively
and frowning over what he'd heard so far. I'd taken what was left--an
overstaffed Victorian love seat that was a lot more comfortable than it
looked.

Alien went on to describe his own attempts to track his father down,
including his initial meeting with Fosse, his phone conversations with
the psychiatrist Martinez at the clinic, and his first encounter with
Baines via the early morning call from the man a week ago Monday.

"The morning of the day Saswald was killed," Riley made a point of
noting.

Alien then quickly summarized how he'd suddenly found himself shut
out--the clinic repeatedly hanging up on him;

Baines and Forbes refusing to meet with him; and later, Baines
rebuffing even Fosse's personal intervention on Allen behalf. As I
listened, his voice remained devoid of any emotion, and he sounded more
like a medical resident reciting the complex medical history of a
stranger than a son talking about his father. I found the detachment
unsettling.

Riley studied his notes a few seconds when the young man had finished,
then asked, "About this abrupt unwillingness of anybody at the clinic
or at Brama to talk with you, it started last Wednesday?"

"Yes sir."

"And in the case of Baines and Peter Forbes, their refusal to meet with
you also began on that day?"

"Not exactly. Forbes refused to see me the day before, early Tuesday
afternoon. But the big freeze from Baines began on Wednesday."

Riley tapped the end of his pencil against his chin and shot me a cold
stare across the expanse of taupe-colored carpet that separated us.

"The timing is interesting, don't you think, Doc? Do you have anything
to add to this sequence of events?" He sounded polite, but I could
tell by the strain in his voice and the swell ofhisjawline that he was
clamping his teeth together again, probably in an attempt to control
his anger at my having kept so much from him.
"About Forbes, I'm afraid I do," I admitted, and described my visit
with the psychiatrist last Tuesday morning. The detective's eyes grew
even blacker when I related Forbes's peculiar reaction to my questions
regarding David being at the clinic.

"What's going on?" Alien demanded, looking from one to the other of
us.

Riley kept his gaze aimed in my direction, letting me have his silent
fury full blast.

"Please, tell me what you suspect has happened to my father," Alien
persisted.

"That's why I came forward, so I could learn what's become of him." His
voice was once more rising sharply, revealing his underlying anxiety,
yet his expression remained rigid and under control enough not to
betray his feelings. Having gotten no reply from Riley, he turned to
me.

"Dr. Garnet, you promised to give me straight answers!"

I felt a surge of sympathy for him.

"As I told you before, Alien, there may be some connection between Dr.
Saswald's murder, Brama itself, and Forbes's death--" "We don't know
anything for certain," Riley snapped, speaking solely to Alien while
making it clear that I was to keep my mouth shut.

"But I would appreciate getting the phone number of the clinic in
Mexico, if you have it handy."

Alien's eyes flashed. For a few seconds I thought he was about to give
the detective the same sort of dressing down I'd received two days ago
when I'd been evasive, but the soldier's self-control won the upper
hand.

"Zero-oneonefive-twosixfive-seven," he recited, making the eight digit
area code sound like his serial number. He followed this with the
local exchange, also by memory. Neither his voice nor his eyes now
held even a hint of the resentment he'd shown only seconds ago, but I
figured it was still there, buried deep within layers of discipline.

The detective finished scribbling the number in his notepad, then said,
"I have one more question. Alien, again about the sequence of events.
What day was it exactly when you spoke to Mr. Fosse the second time
about Brama stonewalling you?"

"Last Friday," Alien replied.

Riley turned to Fosse, who was still half leaning and half seated on
the corner of his desk.

"And that's the day you pressured Baines to be more forthright with the
Pearson family?"

"Yes it was," Fosse replied.

"I was surprised to learn he was in town, but leaped at the chance to
give him hell personally for how his company was handling young Alien's
problem.

Not that it did any good."

"I appreciated your effort, sir," Alien quickly interjected, his
expression softening.

Fosse's bearded face broke into a smile.

"Why, thank you, son," he said gently.

"And I assure you I'm not letting go of what happened to your father,
whether his disappearance has anything to do with this other business
or not. I never met him, but I've always been a fan of his writing."

On that canning note, Riley turned to Alien and thanked him for coming
in.

"One of my men will see you out past the guards at the door--"
"Detective, there's something else I want you to have," Alien
interrupted, reaching inside his breast pocket. He brought out a
standard-sized snapshot.

"To help in the search, here's a photo of him. I know you could get
the one they used for his column in the paper, but it's more than five
years old, and frankly, he looks much more haggard now, on account of
his drinking. This is the latest I have, taken just last spring when I
got my sergeant's stripe. For the occasion, my father put on his old
army uniform--it still fit him--and Mom took the shot. I figure you
can blow up the part with his face in it and make copies for the
Mexican police to show around. But I'd like the original back."

Riley studied the picture for a few seconds, then, without showing it
to Fosse or me, put it inside the notebook he'd been writing on.

"You're the spitting image of your father," he said absently.
Alien, getting up to leave, smiled for the first time since he
arrived. As the two men shook hands he told the detective, "That's
what everybody says."

No sooner was he out the door than Riley started pacing the length of
Fosse's office.

"I could have stopped Pearson from killing Forbes," he declared,
wagging his index linger at me.

"I fucking could have stopped him!"

"Now wait a minute," I protested, "I did what I was obliged to do and
protected my patient's rights--" "You withheld critical information!"
he cried, wheeling around and stepping up to where I was sitting.

"It was medically confidential, which you keep denying."

"It implicated Forbes! I could have put the heat on him days
ago--maybe even arrested him--but thanks to your delaying, the killer
got to him before me."

"Hey!" I sprang to my feet and went eye-to-eye with him.

"You don't think I did whatever I could, legally, to help nail this
killer? I've been pointing you at Brama and that goddamned clinic in
Mexico since the beginning. That's where the real crime was probably
committed in the first place, and Pearson is likely as much a victim--"
"A victim who's maybe hacking heads half off--" "Cool down, both of
you!" Fosse barked, flashing an admonishing scowl as he slid off his
desk to move between us.

He reinforced his edict with a you-should-know-better look, then added,
"Your going at each other seems to have blinded you to an altogether
different scenario which strikes me as being pretty obvious."

The pulsing movement in Riley's jaw stopped.

"Let's hear it," he sighed, giving an impatient wave and wandering over
to stand behind the chair where Alien had been sitting. He grasped its
back with his hands, his thick fingers indenting the upholstery with
their strength.

"As you suggested. Detective, it's the chronology that's key," Fosse
continued.

"Now correct me if I'm wrong, but from the debriefings you've been
giving me, later the same day that Alien Pearson and Dr. Garnet were
upsetting Forbes with questions about David Pearson and the clinic, you
were visiting Baines and his CEO in their Buffalo offices with
identical inquiries of your own, leaving them equally upset.

In addition, you told me earlier this afternoon that within an hour of
that meeting, one of your men saw Forbes striding into Baines's
office--summoned or showing up on his own-we don't know yet. Have I
got all this right so far?"

Riley simply nodded.

"But the following day no one in Brama will have anything to do with
Alien Pearson, and Peter Forbes apparently attempts to manipulate a
patient into murdering Dr. Garnet. It all leads to some pretty
interesting possibilities, doesn't it?"

Riley's disappointment showed in his face. So far this wasn't anything
he and I hadn't already covered.

"What's your point?" he demanded, sounding weary.

"We already know that questions about David Pearson and the clinic make
everyone at Brama nervous."

Fosse continued, undeterred.

"Whether Baines ordered Forbes to try and kill Dr. Garnet to prevent
his asking any more questions about David Pearson and the clinic, or
the attempt was the result of Forbes panicking about what those
questions might lead to and acting on his own," Fosse turned to me,
"either way, his bungling your murder must have left Baines mighty
uneasy."

"Holy shit!" Riley exhaled softly "It could have been Baines who had
him killed!" I burst out.

"To keep him from talking," the detective added, "because he'd become a
loose cannon."

"Baines could have feared that we'd eventually figure out how Forbes
had tried to kill me," I elaborated, picking up the thread of thought,
"and then decided he couldn't risk our arresting Forbes for murder."
"Exactly," Fosse said, leaning back and looking triumphant, the way a
teacher might after making a breakthrough with slow students.

Riley frowned again.

"But how did Baines know we were about to arrest Forbes? Christ, he or
whoever he'd hired to do the killing must have gotten to the
psychiatrist barely minutes ahead of us."

Fosse shrugged.

"Maybe Forbes was frightened enough about your wanting to talk with him
that he phoned Baines to ask what he should do. Maybe he even found
out that you two had been interviewing Martin Whitehead, and he figured
his jig was up. If he'd called Baines in a panic, babbling about
facing arrest for attempted murder, Baines could have determined then
and there to do away with him."

Riley's frown deepened as he digested the possibility.

"Perhaps," was all he replied.

"What's troubling you?" I asked.

"You look a hell of a lot less enthusiastic than you did just a few
seconds ago."

The detective started to pace again, his index finger once more moving
in the air, but this time as if he was doing math in his head.

"If Baines is behind Forbes's murder, we also have to assume he's
behind Saswald's. But from the airline records, we know for sure that
Baines didn't leave San Francisco until after Saswald was killed."

"So?" I shrugged.

"You just said he could have hired someone."

"I know I did, but if I think about it, the savagery of these kills
goes against them being the work of a professional hit man. In
particular, the method's too messy and prolonged. It requires the
killer to hang around until the victim can't crawl or get help, and
that delay increases the chances of his getting caught. Whoever did it
took a lot of risks to make sure that Saswald and Forbes died slowly,
in agony, and aware."

I'd always presumed that the butchery we'd seen was the product of an
insane rage. That anyone could be so calculatingly savage chilled me
to the bone.
"But couldn't Baines have ordered that the killings be made to look
like revenge slayings," Fosse suggested, "to make us think of someone
like David Pearson? You said from the beginning, Detective, that the
scrawled message might have been left by the killer himself to
misdirect the police toward a scapegoat."

Riley seemed to go back to his silent calculations again, frustration
written all over his face. I heard him murmur, "IfBaines ordered up
both murders and is that clever..." He trailed off, stared at his
hands, and began kneading his knuckles the way arthritics sometimes do.
Without warning, he slammed his fist into his palm, the force of the
blow making me wince.

"Christ!" he exploded, coming to a standstill.

"Until I find out what Baines and his crew are up to at Brama or in
that damn clinic, everything else is pure speculation." He threw his
arms in the ah- and flopped down in the fancy love seat, his features
sagging into a show of exhaustion.

"Can you two tell me how an American health care company, an addiction
clinic in Mexico, a psychiatrist, and an anesthetist can be used for
something so illegal that it's worth killing over?"

His question sounded like the preamble to a weird joke.

Fosse looked contemplative but didn't offer up an answer.

I scarcely fared better. But watching the detective sprawled over that
expensive piece of furniture as I considered the riddle he'd asked got
me to thinking about Forbes's taste for pricey chairs.

"Whatever the late psychiatrist was involved in, I bet it put money in
his pocket," I said absently.

"You've got that right," Fosse readily echoed. He sounded relieved
that I'd at least thought of something.

The lines of fatigue etched on Riley's face rearranged themselves into
a show of exasperation.

"Come on, give me stuff that's less obvious and more useful," he
growled.

Fosse grimaced and admitted that he was still out of ideas.

I quickly tried to come up with a different line of thought, but found
myself drawn back to thinking some more about Forbes's lifestyle--of
his receptiveness to perks for his me too research, perks that FDA
regulations had curtailed over five years ago. Then it popped into my
head that the trappings of wealth Forbes was in the habit of providing
for himself-high-priced clothes, top-of-the-line cars, and
travel--hadn't shown any corresponding decline. I hadn't given the
matter any thought before, but now I wondered if he'd found another way
to supplement his' income

"You know, if research is involved," I speculated out loud, "I just
thought of a scam that's unethical as hell, but unfortunately still
occurs. Maybe Forbes was getting kickbacks for providing human
subjects. When this goes on, the money involved is usually disguised
as a 'consultation fee," and the consultant simply persuades his
colleagues to provide subjects from their practices. But one thing
that's a complete no-no, and absolutely illegal, would be to take money
for coming up with subjects who were your own patients."

Now Riley seemed mildly interested.

Fosse's expression, on the other hand, brightened, as if it had been
caught in a spotlight.

"Suppose their recruiting methods weren't the only things that were out
of line," he piped up, his voice filling with excitement.

"As you know, Earl, I sit on our own committee which screens proposed
studies for the hospital, and it's especially tough on any clinical
trials involving human subjects. One reason this Drama bunch chose to
operate in Mexico might be that their research wouldn't pass muster
under either U.S. law or national ethical guidelines."

This idea set Riley's eyes alight.

"You know, there was a case somewhere in the Midwest," he began,
leaning forward in his chair, "where a hospital was giving kickbacks to
a ring of psychiatrists for bogus referrals of Medicaid and Medicate
patients. Basically, those crooks would lock them up and put them on
drugs for a while to generate false claims. Nobody listened when a few
of the victims got out and complained-these people were officially
diagnosed as crazy, right?--but finally the FBI got involved when the
accusations started popping up in more than one state. Could this be
something similar, but involving bogus research? An isolated setting
in Mexico would be an ideal place to avoid scrutiny by American law
enforcement agencies, in case anyone from this side of the border tried
to raise a stink."

"Why would Baines be involved in generating false claims against his
own company?" I asked.

"That doesn't make sense."

"And I doubt the research would be entirely bogus," Fosse added.

"A man like Baines wouldn't risk a dime on whatever they're working on,
illegally or otherwise, unless it promised big profits."

Riley thought a moment.

"Okay, let's come at the problem with a different set of questions. Why
focus on research into alcoholism, and, although I can see a
psychiatrist being involved, why use an anesthetist?"

"Maybe they chose alcoholism because it's such a massive problem crying
out to be solved," Fosse suggested.

"Give me a break," Riley retorted with a groan.

"I doubt this bunch is much motivated by me betterment of humankind."

"No, but that need makes the business of treating addiction worth a
pretty good buck these days," Fosse replied.

"As many as fifteen to thirty percent of hospitalizations are related
to alcoholism, if you count the secondary admission
diagnoses--cirrhosis, GI bleeds, multiple trauma--at a cost well over
one hundred billion a year. A breakthrough on existing treatment
methods could be worth a fortune for HMOs if it significantly reduced
the amount they currently have to pay out for the problem."

"Forbes come up with an innovative idea for a disease as complex as
alcoholism?" I hooted.

"No way! He was a mental midget in the realm of original thinking. Any
research he'd be involved in was bound to be derivative. And the only
new development he could have tried to pirate are anti craving
drugs--naltrexone, for one, and two similar agents still under study.
But even if he'd had a copycat version and was trying to run quickie
trials on it that he never would have gotten away with in the U.S." he
wouldn't need Saswald for a scam like that, so it's unlikely that
that's what he was up to. As for new clinical work on alcoholism that
does involve an anesthetist, / certainly haven't heard of any "Yet as
I spoke, something stirred at the back of my brain, as vague as a
sensation of deja vu. I tried to dredge up a more specific
recollection of whatever it was, and after a few fruitless seconds
decided it must have come from a lecture I'd heard or something I'd
read long ago. But casting through distant memories of all the
marginal medical information I'd been exposed to in the course of a
lifetime was never a profitable exercise.

"Nevertheless, let me see what the Net turns up if I plug in those key
words," I suggested to Riley.

Fosse loosened his jacket, stretched, and wandered over behind his
desk. He started opening drawers as if looking for something.

"What are you going to do with all this speculation, Detective?"

Riley stood, arched his back, and groaned.

"That's the trouble with having only speculation and no hard evidence.
I couldn't use what I've got to pin so much as a parking ticket on
either Baines or Pearson. And as far as investigating the clinic goes,
look at the run around Alien Pearson got, trying to make local Mexican
police launch a search for his father. Unfortunately, our people are
going to have just as much trouble getting anything done in that neck
of the woods--cooperation isn't a watchword when it comes to cops and
international jurisdictions."

Fosse asked, "Will you be questioning Baines about tonight's murder?"

"In a general way. I can't justify getting too heavy-handed with
him."

"And have the media found out yet?"

"We haven't issued a statement," he answered, walking over to a corner
window overlooking the grounds. Tendrils of mist played against the
outer panes of glass, and I doubted he'd see much.

"I'm sure reporters are down there, somewhere, waiting in their
remotes," he said wearily after taking a glance into the night.

"They'd hear the 'possible homicide' call go out on the police band,
and with all our cop cars coming and going, they'll know it's for real.
Even with our ordering all the hospital workers not to discuss what's
happened until we finish questioning everyone, word's sure to leak out
after the eleven o'clock shift change when people head home."

"So specific news of the murder, including Forbes's name and how he
died, will likely break within the hour," Fosse said quietly as he
pulled out what resembled a household phone directory with small index
tabs along the side. I recognized it as the log where he kept all the
chiefs' private numbers, including those when we were at conferences or
away on vacation.

He always insisted that he had to know our whereabouts in case of
emergencies, and what he was holding we'd long ago christened as his
"mother hen" book. I assumed that he would now contact the Chief of
Psychiatry and inform him of Forbes's death. Life must go on, and a
replacement to take over the dead man's patients would have to be found
tonight.

But instead of picking up the phone. Fosse placed both his palms on
his desk and leaned toward a gloomy-looking Riley.

"How would you like to bushwhack Baines at his office early tomorrow
morning? It ought to be very interesting to see how he's reacting to
the psychiatrist's death, especially if he hasn't had a chance to
compose himself and prepare for a chat with the police."

"How do you mean?" the detective asked.

Fosse turned to me.

"Earl, after our discussion about Janet this evening, I set up a
meeting with Baines for eight a.m. tomorrow.

He thinks I'm coming cap in hand with some 'consultants, in order that
we might settle this Garnet trouble once and for all," was how I put
it."

Riley looked mystified until I quickly explained about undesirables and
what Brama had in store for Janet.
"Although it all seems small potatoes now," I admitted, feeling
foolish to even be discussing the problem in the wake of what we'd just
witnessed, "I still have to do something about it."

Fosse's infectious grin once more parted his white beard as he turned
to Riley.

"Why don't you join us. Detective?" he invited, sounding as gracious
as if he were putting together a table for one of his many
fund-raisers.

"You're not serious," Riley exclaimed, looking surprised.

"As odious as what they're doing to Janet is, it's not a felony and it
isn't something that justifies a visit from the police."

"But a threatening phone call is," Fosse persisted, his eyes narrowing
as if he were drawing a bead on a quarry.

"Question the son of a bitch about that, and at the same time see for
yourself if he's behaving like a man who's just murdered Peter
Forbes."
Chapter 14

Brama Tower--a gleaming stone, steel, and glass structure-had been
erected near the shores of Lake Erie on the former site of a rusted-out
factory. It easily dominated the landscape--an otherwise forlorn,
scruffy section of town still littered with the ruins of Buffalo's once
great industrial era--and local commentators had predicted the area
would stay that way, thanks to the garishness of the HMO quarters
scaring off other developers.

Certainly the company had the place to itself.

Not that there hadn't been an attempt on the part of the planners to
blend in. The architectural design of the windows--row upon row of
slightly curved, silvery panes set in peaked concrete frames--had been
an obvious try at mimicking a style found in another celebrated local
landmark, the nearby city hall building. But the latter was a layered,
bulky, thirty-three story tribute in stone to Art Deco, and the try at
melding the two just hadn't worked. The taller, newer structure ended
up making the city hall appear stumpier than ever, and the only effect
of all those highly reflective, specially contoured sheets of glass was
to make the Brama building look as if it was made from a stack of
giant, one-way sunglasses.

As for me, I always thought the facade was perfect, for a sleazy outfit
with something to hide.

As I pulled onto the grounds, the prospect of a face-to-face showdown
with Baines had me pumped with excitement.

Janet was immediately behind me, having driven her own car in case she
was called to a delivery. Minutes later Fosse ar200
arrived by cab. He spotted us easily enough, as at this hour there
were no other cars in the section reserved for visitors, nor were there
many anywhere else in the parking lot. It appeared that Brama felt it
could afford giving doctors and hospitals a head start each morning
before resuming the daily business of telling us what they were and
were not going to pay for.

At five to eight a chauffeured squad car pulled up to where the three
of us stood waiting, and Riley climbed out. He greeted us with a
terse, "Let's go."

While the sun was already making the upper half of the building glitter
silver and gold against a faultless blue sky, down here we were still
in the shade, our breath trailing behind us on the cool October air. As
we strode toward the main entrance, I shivered and sank my hands deeper
into the oversized pockets of the coat I was wearing. Off in the
distance I could see the flashing waters of Lake Erie dancing and
sparkling and seeming to mock the coming winter which would soon
smother it with ice.

It took but a minute for Riley to outline the final details he'd worked
out by which he could convert our visit into official police business
and use it "to soften Baines up, then pluck him clean," as he put it.

I liked what I heard.

Half a dozen security guards were positioned inside the front doors.

"They weren't here last week," Riley muttered as he flipped out his
badge and got the bunch of us waved through to the foyer inside. It
was a massive, high-ceilinged space enclosed with glass--two-way at
this level--and filled with ornamental trees. The centerpiece was a
small landscaped waterfall that filled the air with the sounds of a
running brook.

Looking around her, Janet murmured, "It's like a goddamned hotel!"

Fosse led us to a circular reception counter staffed by two more
guards, who were sipping coffee and loudly debating this year's chances
of the Sabres, Buffalo's extraordinary hockey team. Showing his card,
he announced, "We've a meeting with Mr. William Baines."

"Ah, yes," one of the guards responded, putting down his cup and
shoving a sign-in book at us.

"We've been told to expect you."

Riley smiled at the other man.

"Best goaltending in the league, I figure," he schmoozed, then pulled
out his badge and summoned the startled fellow to meet him a few feet
away, where he briefly huddled with him.

Seconds later as we waited for the elevators the detective quietly
informed us, "The extra security was ordered an hour ago, by Baines
himself."

"Because of Forbes murder?" Janet asked.

Riley shrugged that he didn't know.

"It's a pretty defensive response if it is," I commented.

A few Brama early birds on the way to their offices joined us, and no
one spoke as we were whisked noiselessly to the upper floors in less
than a dozen seconds.

When the doors slid open, we stepped into as lush a reception area as
I'd ever seen. A spread of pastel-blue carpet the size of a putting
green led to a variety of sitting areas, each furnished with beige sofa
chairs and a richly finished coffee table. Everywhere there were
plants, and on three sides of the room hung an abundance of prints,
none of which I recognized and most of which seemed to have been chosen
for their colors, which matched the decor. But most stunning was an
end wall entirely of glass. The view over Lake Erie from this height
was such a startling sweep of deep blue that nothing else in the room
could compete with its beauty.

Yet Baines's secretary, her desk set off to one side, obviously had
gone to the trouble of giving it a good try. Her model's looks were
enhanced with gold-speckled powder, her casual cascade of black hair
had been carefully arrayed in place with mousse, and her long nails,
exquisitely painted a soft pink, must have commanded at least an hour's
worth of attention that very morning. While Fosse announced himself,
I caught her eyeing Janet's natural complexion and boyishly coiffed
blond hair with what could only be called a competitive once-over.

When the woman finally did take in the rest of us, she said, "He's
expecting you--" but at the sight of Riley who'd made it a point to be
last off 'the elevator, cut herself off and demanded, "Detective, what
are you doing here? He didn't tell me anything about your coming--"
"I'm with them," he quipped, and strode over to a double set of doors
set in the wall behind her. She started to protest, her makeup
exaggerating the look of alarm in her face. With a disarming grin, he
quickly added, "Don't worry, I know my way."

We followed after him before she could say or do anything more. Once
inside, we were facing a very startled, very slender, immaculately
dressed man who'd already sprung to his feet behind a desk that would
have dwarfed even Fosse's.

"What the hell?" he uttered, silhouetted in front of another
wall-sized window overlooking the lake.

He had closely cropped blond hair verging on white, a lean, handsome
face, and, even though he was of medium height, his compact physique
made him an imposing figure.

But then I got a good look at his eyes. Though they were the same
color as the lake behind him, they lacked its brilliance, and even as a
dark scowl spread across his forehead, his anger failed to ignite a
spark in them.

"Mr. William Baines," Riley began, his voice coldly officious.

"I think it appropriate that before we start this session, I read you
your rights."

"My rights!" he gasped, growing flushed despite his California tan.

"Yes, your rights, because if I'm not satisfied with the answers you
give me today, you may be leaving this building under arrest."

"Jesus Christ!" he uttered.

"What are you talking about?"
"You have the right to remain silent. You have the right to an
attorney being present..."

As Riley intoned the familiar refrain, Baines's expression quickly
changed from fury to one of fall alarm. Yet his eyes remained
lusterless, as if they were switched off from what was happening. And
from the way the skin below them sagged in tiny, dark pouches, I could
tell that the man whom more than anyone else I held responsible for the
death of little Robert Delany wasn't sleeping.

"... anything you say can and will be used against you..."

I found it strange. I'd arrived thirsting for my chance to have at him
and bring him to account, yet I'd been expecting a fiend in fall roar
who'd be brimming with arrogance. Instead I was confronting someone
whose gaze was dull and fall of dread, almost haunted. Nevertheless,
once Baines started squirming and looking indignant under Riley's
interminable warning, my anger at him for what he'd done returned with
a vengeance--and waxed and waxed.

"... if you cannot afford an attorney, we will appoint one for
you..."

Yeah, right, I scoffed, looking around at the lavish surroundings.

Knowing the price that patients had paid so he could afford the decor
served only to jack up my fury a few notches more.

Turning from Riley, Baines pointed at Fosse.

"You set up this meeting to settle the Garnet business," he accused.

"

"Once and for all," you said!"

"That's what we're doing," Fosse replied quietly.

A look of genuine confusion swept over Baines's face.

"What the hell has your bringing the police here to do with Garnet?" He
then gestured toward Janet and me.

"And who the fuck are these two?"

Fosse suddenly bristled.

"That's Dr. Earl Garnet and Dr.

Janet Graceton," he snapped.

"You should at least know the faces of the people whose careers you set
out to destroy. Oh, but that's not your style, is it, Baines? You
never do see the faces of the people you mess with! Did you ever even
bother to look up a photo of the Delany infant?"

Baines's color went from red to white, and a sheen of perspiration
appeared around the follicles of his short hair. He kept glancing from
Janet to me, stammering, "I--I--I've done nothing illegal, nothing, you
hear me? And if you think you can bully me with false accusations--"
"... and do you understand these rights as I've read them to you?"
Riley concluded, raising his voice enough to cut Baines off and grab
his attention.

"I understand nothing!" Baines protested.

"Then get your lawyers in here," Riley replied, his voice smooth and
cold as ice.

"They'll explain it to you."

"Explain what?"

"Are you waiving your right to counsel?"

"Counsel about what?" Baines cried, his voice halfway to a shriek.

"You mean you don't have any idea what this is about?"

The beleaguered CEO sank back into his chair, repeatedly trying to
swallow, but he didn't seem to have enough spit.

"No, I don't," he finally replied, sounding shaky.

"Do you want me to tell you, without your lawyers here? I warn you, in
front of these witnesses, that I'll use whatever you say in a court of
law."

Baines looked up at us, his pupils so dilated that the irises around
them had become thin blue rims. My God, he was afraid, I marveled. Was
it solely of us--that we knew what he'd done? Or had it something to
do with whatever was robbing him of his sleep and put that look of
dread in his eyes before we'd ever walked in on him?

"We're investigating a threatening phone call placed to Dr.

Garnet's home three nights ago, on Monday evening," Riley continued.

in the parking lot he'd confided to us that after "softening Baines up
by reading him his rights," he intended to keep him guessing about how
much we knew through a series of "carefully planned, insinuating
questions."

"Now, Mr. Fosse here attests that you have demonstrated a great deal
of hostility toward Dr. Garnet recently. Would you care to comment on
that allegation?"

"He what?" Baines exploded, swinging his fill! attention over to the
normally kind-looking sexagenarian, only to be greeted by a steely
glare.

"Given that you've strong-armed our entire board to fire Dr. Garnet,"
the older man retorted without hesitation, "I figured the police should
be made aware of anyone carrying that big a grudge."

Baines mourn curved south in a sneer.

"Why, you meddling old fart--" "It makes you or someone working for you
a prime suspect for having initiated those calls," Riley cut in.

Baines was starting to resemble a man watching a tennis match.

"You can't be serious!" he snapped, swiveling his head back around to
face Riley again.

The detective stepped up directly in front of him and leaned across the
desk.

"You bet I'm serious. Two physicians at St.

Paul's have already been murdered. There's also been an attempt made
against Dr. Garnet's life, or do you already know about that as well?
Make no mistake, Mr. Baines. Anyone suspected of threatening Dr.
Garnet is in a lot of trouble."

In less than a heartbeat the pinched lines of rage in Baines's face
widened into a show of startled, opened-eyed surprise.

"An attempt against Garnet's life? What are you talking about?"

"You claim to know nothing of that?"

"Of course I don't. Someone tried to kill Garnet? My God!" He darted
a frightened glance in my direction.

If he was lying, he was stellar at it, I decided. But a corporate
sociopath would be, wouldn't he?

"You don't deny your hostility toward Dr. Garnet?" probed Riley.
"My battle with Garnet had nothing to do with anything personal!"
Baines proclaimed.

"It was because the man was attacking the very foundations of managed
care and threatening to undermine the confidence of the millions of
Americans who rely on us for the maintenance of their health..."

"Gimme a fucking break, Baines," I butted in.

"I attacked Brama because you let a child die!"

His only response was to up the volume.

"... thereby jeopardizing a system that has finally offered
unprecedented access to health services."

I nearly puked.

"So this is the pitch of the man whose company more than any other in
America plays and espouses the game of 'withholding payment,"

" I fired back. It was all I could do to keep from lunging at him.

Riley kept the pressure on him, giving the man no chance to start
arguing with me.

"You of course know that Peter Forbes was murdered last night."

Baines caught his breath and appeared to have trouble swallowing again.
His pulse was fluttering at the base of his neck, his face was still
pale, and his pupils remained as dilated as before. Each was a sign of
his surging adrenaline levels--what physiologists call the "fight or
flight state"-our most primitive response to fear. I couldn't tell
whether he was preparing to bolt or mount an attack.

"Yes. It's awful," he said.

"I caught the news on the radio this morning--that poor man, dying so
horribly." Baines spoke in breathless spurts.

"I

even ordered extra security, because, like Dr. Saswald, Peter Forbes
also worked for us. I couldn't help but think that other physicians
associated with our company might also be at risk of becoming targets."
He stole another glance my way.

"But now you tell me this killer tried to murder Garnet?" He was
almost whispering, as if he preferred that I didn't hear the
question.

Riley cocked his eyebrows and treated him to an inquisitor's silence.
Baines resumed his squirming again, until the detective softly asked,
"And why would you expect that someone would want to harm doctors who
worked for Brama?"

Baines literally choked on whatever spit he'd managed to muster up.

"Why, uh, well..." he stammered, then, nicking another glance at me,
leaned forward to Riley, as if he was once more attempting to keep me
out of their conversation.

"Detective, I was actually going to call you about that matter.

You see, we've had trouble before at our other offices, particularly in
San Francisco, where local extremists have gotten patients' groups all
lathered up and made them hostile as hell toward us." His voice grew
louder.

"As a result we've received obscene phone calls, bomb threats, even
extortion attempts."

"What's your point?" Riley demanded.

Baines swung his gaze back toward me, his face flushed with anger
again.

"My point. Detective," he blasted at full volume, motioning toward me
with his index finger, "is that troublemakers like Garnet here stir up
the public and instigate these kinds of attacks. He's the one you
should blame for what's happened to Saswald and Forbes! If he hadn't
mouthed off about that kid--" I lost it.

"You creep!" I roared, and lunged across the desk at him. I yanked
him forward by his necktie until my face was inches from his.

"You killed Robert Delany, and you think that's just fine because
legally no one can touch you for it."

"What the hell!" he sputtered, making a grab for my hands.

But I hung on.

"And of course you must be laughing your head off that my wife and I
don't have any legal recourse to stop you from destroying our
careers."

"Jesus Christ! Detective, stop him," he called out, struggling to free
his tie, and himself, from my grip.

I gave him another hard tug, and watched his pupils swell even
larger.

"But you're frightened, Baines. Why? Have you also done things that
we can catch you on--illegal, terrible things? Is that why you look
scared shitless?" So much for pussyfooting around with "a series of
carefully planned questions."

Better to bombard the creep with accusations.

"Doc, stop it!" Riley growled, grabbing my shoulders.

"Earl! What the hell are you doing?" Janet yelled.

I was beyond listening.

"You know that Forbes tried to kill me, don't you? Maybe you even
ordered him to. Is that the reason he's dead now, to keep him from
implicating you?"

"What?" Baines squeaked.

Riley's grip tightened.

"Shut up. Doc!" he ordered.

I not only held on, I pulled Baines close enough that I could smell the
sweat off him and see his pupils pulse wider still.

"It's the clinic in Mexico that's got your dark secrets, isn't it? What
are you up to down there? In particular, what happened to David
Pearson at that place?"

His eyes dilated further.

"Shut up and get away from me," he shrieked, trying to ply my fingers
open, with no success.

To Riley, he hollered, "Get him off me, damn it!"

"Let him go. Doc!" Riley commanded again. But this time his grip
remained the same.

"Earl Garnet, you idiot! Stop it!" added the love of my life.

I took a measure of the alarm in Baines's face. Not enough, I decided,
and pushed harder.

"And why was Saswald killed?

Because he had something to do with research in the place that wasn't
exactly legal?"

Baines's mouth dropped open. I was sure I'd hit a bull's-eye.

Riley racked up the pressure in my shoulders a nudge, but it suddenly
flashed in the back of my mind that this was but a shadow of what those
powerful hands of his could inflict. He could have had me off Baines
in seconds.

"Now, Doc! Drop the tie," he thundered convincingly just as I grasped
that he must be actually letting me have a go at the man.

Instantly spurred on by having the cop's permission, I screamed into
Baines's face, "What happened to David Pearson?"

Once more his pupils pulsed wider, to the point where the blues of his
irises were barely visible, then constricted a bit. I knew I must be
probing near whatever had him so frightened, and I was about to press
him with more questions when Riley unceremoniously dug his thumbs into
my armpits, and currents of numbness swept into my hands.

"Let him be. Doc!"

he said into my ear.

I had no choice. My fingers went paralyzed and my grip released by
itself. Baines flopped back in his chair with a startled yelp and
stayed put. Riley then hefted me easily to one side and took my place
in front of the shaken executive, leaning over the desk at him.

"You know what I think frightens you most of all, Mr. Baines?" he
said.

"It's the possibility that this killer is someone who's escaped from
that clinic, and now he's returned to get even with the people who sent
him there. That means Saswald is one, Forbes is two, and before you
know it, maybe you'll be number three."

As Riley spoke, I watched Baines's pupils finally expand the rest of
the way until his eyes went fully black with fright and stayed there.
We'd hit the core of Baines's nightmare.

But the detective wasn't finished with him.

"Do you know what it will be like, Baines, when he gets to you?" he
continued, still standing over him and speaking in little more than a
whisper.

"Even when this killer's blade slices as deep as we've seen, it
probably won't make much more than a soft whisking noise. What you'll
hear is yourself sucking air through the slash in your neck. And as
for what you'll feel, knife cuts sear you at first, like a line of
acid. But then the real pain will come, waves of it, along with the
blood. I've been with men as they've died from a knife wound--it's
agony heaped on agony. Dr. Garnet figures with this kind of slash to
the neck, you'll take ten minutes to go."

I thought his eyes would bulge out of their sockets.

"You bastard!" he croaked, his voice breaking. He fought to control
his breathing, then gave a sob.

"Christ! You're a fucking bastard!"

His eyes brimmed over with tears.
* * * "Nobody could ever fake being that scared," Riley asserted from
the backseat of my car.

"As far as I'm concerned, the man truly believes he's next in line to
have his throat cut."

"He was afraid, that's for sure," agreed Fosse, who was in the
passenger seat beside me.

The three of us were returning to St. Paul's, having left a very
unhappy William Baines surrounded by a pack of equally unhappy lawyers.
They'd all been threatening to lay charges against me for assault and
against Riley for police brutality.

"The only thing that got assaulted was your tie," Riley had told Baines
as we were leaving, "and I never laid a finger on you."

"You intimidated me!" Baines had yelled after him.

"I simply made sure you understood what you might be up against," Riley
countered, "in case you might want to disclose everything you know
about David Pearson, to help us protect you from him."

His lawyers had wanted to continue the fight, but at the mention of
David Pearson again, Baines signaled them to be quiet and ordered us
off the premises.

"The minute I saw how frightened he'd become," Riley continued, "I
figured he couldn't be behind the killings, but I had to press him to
be sure. By the way. Doc, you zinged him nicely about the clinic." He
leaned forward and gave me a friendly nudge on the shoulder.

"His reaction, as far as I'm concerned, told us that our guesses came
pretty close to what's going on down there."

Pulling up to a red light, I smiled at the acknowledgment, thinking
that we sounded like members of a sports team complimenting each other
after a successful game. But Janet hadn't been thrilled by my
performance.

"You idiot!" she'd berated me later in the parking lot.

"If he had sued you, and won, you'd have lost your license." She'd
then given me a hug and raced off to a delivery.
"But how could you tell that he was afraid of being murdered," Fosse
asked Riley, "as opposed to his being afraid that you'd find him out
for whatever scam he's involved in?"

"Did you ever see a man who's afraid for his life?" the detective
replied.

"It's the biggest fear there is--the sort that settles into the eyes
and stays there--the kind that I saw in him today. His look reminded
me of men I've seen on death row or people who know there's a contract
out on them."

"Or in a patient who knows he's terminal," I quietly added, confirming
Riley's observation.

We rode in silence for a while.

We were at the next stoplight when Fosse asked Riley, "So you were
serious when you suggested that it's David Pearson who's gone on a
rampage?"

"I guess so," the detective replied after considering Fosse's question
a few seconds.

"But I'm back to my old refrain. If we're going to make a case against
Pearson for Saswald's murder, we need solid proof--not only of the
anesthetist being at that clinic, but also of his having had contact
with Pearson.

So far we have neither."

We sat in silence again, waiting for the light to change.

"Wait a minute," Fosse declared, "I just thought of how I might get you
the proof you need. Hell, I may even have had it in my hands last
night!"

"Proof?" Riley said, sounding skeptical.

Fosse ignored the detective and instead tapped me excitedly on the
shoulder.

"Earl, it's my directory where I keep track of departmental chiefs when
they're away."

His mother hen book.

"All those weekends Saswald was off working at Brama facilities," Fosse
continued, "I have their phone numbers."

"My God!" I exclaimed.

"Hey!" Riley broke in.

"One of you better tell me what the hell you're talking about."
Out of the corner of my eye I saw Fosse give the detective a grin.

"As soon as Earl gets us to the hospital, I'll give you the link you're
after," he promised.

The light changed and I gunned the accelerator. With Riley on board I
didn't think a speeding ticket would be a problem.

By the time we pulled through the gates of St. Paul's, Fosse had
already explained to Riley his insistence on knowing where his
departmental chiefs were when they were traveling.

"And I don't accept calling them on their cell phones.

Half the time they turn them off, and just as often they're in a dead
zone," he continued as we rushed into the hospital.

"They leave me numbers from all over the world--Asia, Europe, South
America--and an exchange from Mexico wouldn't even have made me think
twice. In fact, Saswald was away so routinely over the last year, most
times he simply told my secretary where he could be reached, and she'd
enter it into the book."

Minutes later we reached the hushed domain of Administration and
trooped into his office.

"Now, to cover his tracks, he may only have given the Brama number for
their headquarters in San Francisco, expecting them to forward any call
from me," Fosse continued, pulling out the familiar directory from his
desk as Riley and I crowded around.

"But since he was away mostly on weekends, outside regular office
hours, I'm hoping he felt he couldn't rely on anything less than
leaving me the actual clinic's exchange." Flipping it open, he asked,
"When did Pearson get transferred to the clinic?"

I gave the date, remembering it from when I'd checked his chart.

While Fosse found the appropriate page, Riley pulled from his pocket
the pad where he'd written the number. With it came the photo that
Alien had provided last night, and it fell onto the desk. While I
waited for Fosse to find what we wanted, I found myself staring at the
image of the young Marine and his gaunt-looking father.

"Here!" Fosse exclaimed excitedly.
"Saswald was away four and a half weeks ago," and he quickly read out
a long stream of figures that sounded familiar.

"Bingo!" Riley cried out.

"They match."

"Do we call the clinic," Fosse asked eagerly, picking up the receiver,
"and see if they'll verify knowing him? My Spanish is pretty good."

The detective laid a restraining hand on Fosse's arm.

"I already phoned yesterday evening, after leaving here, but only got
the night staff. The manager of the place and the psychiatrist who
took care of Pearson won't be in until eight o'clock their time." He
glanced at his watch.

"With the difference in zones, that's not until eleven this morning,
another hour and a half" "What are you going to say when you do speak
with them?" I asked, looking up from the picture.

His forehead creased.

"Good question. They're sure to follow the same party line as
Baines--that Saswald's never been there. And after what we put Baines
through this morning, the warning's certainly going to go out, if it
hasn't already, ordering them to beware of American cops, particularly
ones asking about Saswald and research. Now if you'll excuse me, I've
got to call my office." He stepped over near the window and punched in
a number on his cellular. Before he lowered his voice out of earshot I
heard him order, "Let the hounds loose-everything we prepared
overnight. It's Pearson we're looking for. But keep it solely a
missing person's angle. I don't want to connect him publicly with the
killings just yet,.."

While we waited for him to finish. Fosse picked up the snapshot and
casually looked at it.

"You know, I really don't think you hurt your own cause any by pressing
Baines the way you did. It'll buy us a bit of time, and maybe I can
get the Robert Delany fund operational sooner than expected." He
glanced up and caught me looking at him in amazement.

"What, you think I'm obsessed with this Brama business?"

"I think the relentlessness of your opposition to Brama is
remarkable."
He grinned.

"You left off, 'for an old fart."

" Then his eyes sparked darkly and his face folded into a scowl.

"It's not remarkable at all. Earl," he said curtly, and I felt as if
he were scolding me for saying so.

"My mother died of breast cancer, and my father worked himself into a
heart condition trying to pay the bills. After my mother's death, he
got progressively sicker, and I watched his doctors treat him with the
same sort of indifference and dismissive arrogance that HMOs now
institutionalize and make into a business. Then my grandfather and a
few of his 'colleagues' paid some of those doctors a visit. After
that, my father received first-class treatment all the way, except
'their care' came too late to help, and what he really got was a
first-class trip to his grave. My grandfather helped whenever he
could, but I basically ended up raising my younger brother and sister
on my own, so I know what sickness and medical expenses are all about,
in spades. Years later I got another taste of that same arrogance.
This time it cost me my wife and an unborn son--an obstetrical resident
dismissed her complaints of headache and heartburn as unimportant, and
she died of eclampsia--" He checked himself, falling silent, but fiery
bitterness remained in his gaze.

"Sorry," he quietly murmured.

"As I said last night, I shouldn't talk about this when I'm emotional.
But everything I've stood for in my professional life is rooted in that
family history of mine, you understand. So it isn't likely that my
commitment to stand up against the likes of Baines and Brama could be
anything less than total."

I stood motionless, feeling uncomfortable and saying nothing. I'd
known Fosse was a widower, but little else of his personal life. I'd
had no idea that he'd fashioned his professional avocation out of such
tragedy. I also hadn't a clue what to say about such a string of
misfortune that happened so long ago.

To my relief he shrugged and indicated the topic was closed by looking
once more at the photo of David and Alien, which he still held in his
hand.

"Boy, they could be twins," he
216 THEFKOCEDVRE

muttered, tossing it back on the desk, "except of course the son is too
young."

"Pardon?" I queried, suddenly gaping at him.

"Can you repeat that?"

"Look, I didn't mean to embarrass you with details of my past, and I
really don't want to talk about it anymore. All I meant to explain was
that if you find my commitment to stand up against Baines rather
extreme, it's that way for a good reason " "No! I understand that
perfectly. I meant what you said about the Pearsons."

The space between his eyes furrowed.

"Why, just that they looked enough alike to be twins, except of course
the difference in ages. It was a silly comment, really."

"Oh, right," I answered, trying to make it sound as if it were of no
consequence that I had simply misunderstood him in the first place. But
his "silly comment" had just sent my thoughts snapping through a
180-degree turn, and the words scrawled beside Saswald's body in blood
had abruptly taken on an entirely new meaning. Worse, their
implications were rapidly making me feel ill.

At that moment Riley completed his call and rejoined us.

Had he overheard Fosse? Would he also pick up what I'd just realized?
I didn't want him to, not yet, maybe not ever. First I had to think it
through. Maybe on closer scrutiny the idea would seem so farfetched
that I could dismiss it.

The detective arched an eyebrow my way.

"You look startled, Doc," he said.

"Did you think of something else?"

I gave a little laugh.

"No, not at all."

He skeptically raised both brows, but then turned back to Fosse.

"I'm going to need that book of yours as evidence..."

Their conversation faded into the background as my mind raced. If
Saswald had known only David, and hadn't been aware that David had a
son, it could be possible, I reluctantly concluded.
What the dying anesthetist may have been attempting to tell us was
Pearson, but too young... That his killer looked like David Pearson,
except that he was too young.

He may not have known his name, nor even who he was, but he could have
been describing Alien.
Chapter 15

Recheck The facts, I kept telling myself. Make sure I hadn't made a
mistake.

But once the idea took hold that Alien could have been the murderer, it
made frightful sense. Because he might have been avenging his father,
either acting in concert with David on his behalf or extracting his own
revenge for whatever Saswald and Forbes had done to the man. Being a
trained Marine, he'd know how to cut a throat. As for his whereabouts
at the time of the killings, the police could check that out at his
base. Pray to God he's got an alibi, I thought, appalled by how
readily my thinking the worst of him was gathering its own terrible
momentum. But his motive had come so easily to mind and seemed so
credible that the rest of the scenario practically wrote itself.

And then I realized that maybe I wasn't the only one to have suspected
him. When Martinez, Baines, and Forbes had suddenly not wanted
anything to do with him, had it been because they also believed he was
the killer?

I looked over to Riley, who was still talking earnestly with Fosse. At
one and the same time I dreaded the detective suspecting Alien and yet
wished he would. Because as long as I kept the prospect of Alien's
guilt to myself, and neither Riley nor anyone else thought of it, I was
covering up for the son exactly as I had for the father.

I looked back at me photo and stared at it for a few seconds.

Damn you, David, I cursed. When will I ever be free of you? 218
"Jesus, Doc, are you sure you're all right?" I heard Riley ask.

Snapping out of my daze, I saw both the detective and Fosse staring at
me, their brows creased with concern.

"Yeah, what's wrong?" the older man added.

"You don't look good at all."

I had an ER to run. At least that's what I'd said to Riley and Fosse
after assuring them that I was only overtired, so as not to make my
quick exit seem too conspicuous.

But I had a lot of trouble keeping my mind on the job. Even seeing
patients with routine problems required all the concentration I could
muster, and my ineptness in performing administrative duties soon had
Susanne fit to be tied.

"Everybody's as distracted about Forties's murder as they were about
Saswald's. In fact it's worse," she warned.

"What with all the rumors that a maniac's loose in the hospital and
stalking our staff. Your not being here didn't help any either. For
God's sake talk to them now, like you did before."

But what could I say? Telling them at this point that Forbes and
Saswald were probably involved with something illegal and that they
were killed in some kind of revenge slaying was out of the question.
Riley would go ballistic, and the media would have a field day.

"Susanne, I don't think anybody here is in personal danger, but the
details are police business, and I'm not at liberty to discuss them."

"Then please, at least tell them that!" she snapped, her growing
frustration evident.

"We're having close calls again."

I made the rounds and said what I could, but whenever anyone asked a
question, my evasiveness obviously made them even more uneasy.

To make matters worse, more HMOs than ever were only giving provisional
approval for admissions, and increasing numbers of patients were
signing themselves out against medical advice.

"... too big a risk. If they don't pay the bill, it would bankrupt
us..."
"... that's our food money..."

"... hey, man, clothes for the kids, gas for the car--you know how it
is..."

Not only did the incidents increasingly involve HMO providers other
than Brama, after a few phone calls to other hospitals, I discovered
that the trend was citywide.

"Collusion!" cried some of my staff.

"Monkey see, monkey do!" the others insisted.

"What are you going to do about it?" a worried Michael Popovitch
asked.

I didn't know.

By early afternoon I'd argued myself hoarse to no avail with triage
officers from over half a dozen HMOs.

"We simply issue payment guidelines. The medical decisions, and the
responsibility, remain with you. Doctor," they'd all parroted, ever so
sweetly.

"Nice try!" wheezed a fifty-year-old asthmatic who couldn't risk being
hit with a bill for the few days I felt he needed to stay in the
hospital. As I presented him with a release stating that neither I nor
St. Paul's could be held accountable for whatever happened to him if
he left ER, Susanne muttered, "Why not ask him to sign his own death
warrant?"

Riley phoned shortly before two.

"As expected, everyone at the clinic denied knowing Saswald, and all of
them kept reciting the line that an addiction center had no need for an
anesthetist," he reported.

"By the way, did you have a chance yet to check out the Net for any
experimental stuff that might make the connection?"

I'd been so preoccupied with our problems in ER, and wrestling with
what I should do about Alien, that I'd forgotten.

"Sorry, I'll get to it as soon as I can."

"Okay, Doc. But I hope you'll find me something. I need a definite
lead on what that place could be up to, or I'll never get the local
cops to give it so much as a glance. Already they're doing the
jurisdictional jitterbug about our request that they issue an APB down
there on David Pearson in case we're wrong about him being back in
Buffalo. All I got them to agree to was their notifying us if he turns
up. I know young Alien's going to be disappointed, but even I've got
to admit that a full search on their side of the border, under the
circumstances, doesn't seem justified."

I thought of how adamantly Alien had wanted that search.

Had his insistence been a ruse, an attempt to fool us into thinking
he'd had no contact with his father up here? Or perhaps it had been an
attempt to keep alive, for our benefit, the possibility of what would
be his father's best alibi--that he was still in Mexico. In fact,
Alien coming forward and making a voluntary statement right after the
murder might have been a carefully planned move intended to deflect
suspicion away from himself.

"And, Doc, I finally got to look at David Pearson's chart.

I've been thinking. Perhaps you should continue to be careful."

"Of David?"

"Of course I mean David. Who's to say he's only going after the
doctors affiliated with Brama who took care of him?

I'm warning all the physicians who are listed in the dossier to be
careful. Your name appears more often than any of them."

It was evening by the time ER fell quiet enough that I could retreat to
my office and log on to the Internet. As the machine repeatedly
attempted to dial me through, I sat and listened to the sound of rain
against my solitary window--a postage stamp-sized affair that allowed
light to come in but was too opaque with grime to let me see out.
Tonight it lit up with the occasional fucker of lightning, and I had
barely counted three steamboats before the thunder rolled overhead.
Obviously, after such a bright start to the day, the weather had turned
for the worse--like my state of mind.

I clicked into the Med-Line program--a service that indexed all major
medical publications--entered my four key words--alcoholism, research,
anesthesia, psychiatry--and requested a search spanning journals from
the last five years.

Within a minute I had three pages worth of abstracts to scroll through.
Most pertained to new protocols for anesthetic problems during
emergency surgery on alcoholics, some dealt with recent competency
issues for doctors obtaining informed consent pre operatively from
inebriated patients, and none of them were of any use to me.

Perhaps what I'd so vaguely remembered was from more than five years
ago. I punched in the instructions to extend the search period back in
time. To narrow things down, I changed my key words to read: addiction
research, anesthesia, psychiatry.

This time I got absolutely nothing.

Further back still? I knew Med-Line only included titles from 1980 on.
I punched in the request and let the computer prowl through the
cyberspace equivalent of ancient memories.

This took longer, and I had time to appreciate that the storm outside
was crackling and booming more fiercely now.

One particularly strong shot of lighting made the computer protest, but
the tenacity of the microchips won out, and the connection held. Not
that it did me any good. Once again my screen came up blank, a
flashing marker on the blue emptiness inviting me to enter another
question. But I couldn't think of anything else to ask. Whatever
Forbes and Saswald had been up to, it was beyond the ken of the
computer world.

Before signing off, I checked my e-mail to see if Jack MacGregor had
gotten back to me yet. After four days, there was still no reply.

I was soaked through before I'd gotten halfway to my car.

The lot was barely a quarter full, the visitors having gone home hours
ago, so I could sprint more or less a beeline across the open asphalt.
But my late arrival this morning meant that I was stuck in the outer
limits of regular parking, and the deluge was so strong that to get
there, I had to skirt entire areas where the pavement was submerged in
inches of water. Already loud, the downpour teemed into these pools
with such force that I wouldn't have heard a shout from ten feet away,
nor would anyone have heard mine.

I paused at the edge of a particularly large flooded section and
debated plowing-through or finding a way around. My clothes wouldn't
get much wetter than they already were if I took the longer route, but
at least I'd spare my shoes and myself the unpleasantness of a
"soaker." I hurriedly took the detour.

When I finally had my car in sight, I deactivated the alarm with my
remote as I ran toward it, then flung open the door and squished into
the driver's seat. Removing my glasses, I proceeded to wipe away the
water streaming off my hair and into my eyes. The drumming on the roof
was even louder than the noise of the storm outside, and the windows
were so awash that I could barely see out of them.

Shivering as cold rivulets ran down my back, it took me half a minute
more to clean my glasses before I retrieved my keys from my coat pocket
and reached for the ignition. In the process I glanced in the side
mirror on my left, and froze.

Three dark figures blurred by the rain were approaching the car,
fast.

At first I was too taken by surprise to move. I wasted another instant
thinking they might simply be people running for their vehicle just as
I had. By the time I grasped that there were no other cars around me
and made a quick stab for the power locks, the door behind me flew open
and a gruff voice ordered, "Don't move!"

My keys still in hand, I jammed them into the ignition and started the
motor. Immediately my upper arms were grabbed from behind and yanked
backward as I strained to reach the stick shift and get into drive.
Both doors on the passenger side of the car opened in unison, and I
could see two people in black ski masks and rain wear. This killer
wears protective gear against the blood was all I could think of.
My rocketing fear gave me the strength of a madman. I managed to
twist and get my right leg up to deliver a few kicks toward the one
coming at me through the passenger door. The one entering by the rear
reached over, grabbed me by the hair, and pulled my head back over the
top of the seat.

"Behave!" he barked, applying more tension, but the pain in my scalp
was nothing to the terror I felt with my neck so exposed and ready for
slicing. I started to flail and kick so hard that I nearly wrenched
free of the one behind me who was holding my arms, and felt the toe of
my right shoe make contact with what I thought was the chin of the
attacker in the front seat. For my trouble I got a round of curses and
my head yanked even farther back.

But what was a little hair loss to a man about to be slaughtered?

I whipped my trunk and neck forward, letting out a roar, while both
feeling and hearing the roots rip from my scalp.

"What the fuck!" uttered the one left with a handful of hair.

This time my forward momentum also broke me free from the man directly
behind.

"Stop him!" he yelled, trying to regain his hold on me as I grabbed
the door latch with a quick pull and lurched to my left, evading his
grasp. At the same time I drew up my knees and delivered another kick
at the face of the man in the front seat, who was also reaching for me
again. The force of the blow sent him flying backward until his head
hit against the top of the door frame, and the recoil was enough to
shove my head and shoulders out the open door at my back. I propelled
and wiggled myself the rest of the way from the car, sliding onto the
pavement and eluding the two trying to grip me from over the
backseat.

"Get him," screamed the guy who'd sampled my hair.

I saw the rear door on my side start to open as I scrambled to regain
my feet and run. But my shoes slipped on the wet surface and I went
down again, while the man coming out of the car launched himself at my
legs. I managed to roll on my side, draw up my knees again, and
deliver another kick just as he was about to land on me. My shoes
caught him on the side of his head and he roared with pain, his neck
snapping back as he fell to my right.

I once more tried to get to my feet, but could see the other two
already coming around each end of the car toward me.

If I could just keep my footing this time, I prayed, rising on my
hands, and pushed off in a slipping attempt at a sprinter's start. My
right sole caught some traction, my left a little less, but I was
started.

"Stop, you fucking asshole!" screamed one of the pursuers above the
din of the rain. I knew there was no chance of anyone but me hearing
him. I doubted a passerby near the hospital could even see our little
drama in the dark. I had to get closer to the building.

A different voice bellowed, "We're taking you to Jack!"

Jack the nicking Ripper's more like it, was all that clicked in my head
as I lurched forward, picking up speed. But my feet were sliding far
too often. I paid no further heed to what they were yelling, pumped my
knees as hard as I could, and, still accelerating, thought only of
getting away.

Nearly upright, I felt an outstretched hand sweep down my back, missing
me, then heard another volley of curses, but didn't risk a glance over
my shoulder. Instead I poured on the speed, and began to think I might
actually make it.

The rain was so heavy that I was inhaling water and choking as I ran.
From barely a few steps behind me I could hear the labored breathing of
my pursuers, and knew they were having the same trouble I was.

Directly in my path lay the large pool of water I'd skirted on my way
over, the rain teeming across the reflection of the hospital lights on
its surface. Would it slow me down? No more than it would them, I
decided, and splashed through it.

It took me a few seconds to realize I had only one runner behind me
now. Peripherally I could see the dark shapes of the other two going
around the water, one on either side of me, and they were pulling
abreast. I could already tell that by the time I got back on un
submerged asphalt and on an even footing, they'd be slightly in front.
Could they then angle back toward me in time to cut me off? The thought
of once more being in their hands jolted me to new speed.

No one was yelling anymore. All I continued to hear above the sounds
of the rain and splashing footsteps was my own noisy breathing blended
with that of the man behind me. A flash of lightning illuminated the
two side runners as they began pulling ahead. The staccato nicker sent
their smooth movements into the jerky motion of a film at fast-forward.
Then the darkness returned, and a roar of thunder passed over us.

I ran free of the water seconds later, but they'd already adjusted
their course and were closing in to intercept me. I tried to gauge the
point up ahead where I'd either be by them and free, or tackled and
captured. One way or another, I'd know in a matter of seconds.

I started a count to help me time my moves. I'd covered ten more yards
and reached the number two by the time they were near enough that I
could see their eyes behind their masks as they lined me up.

The one on my left flew at me first. I managed to straight arm him in
the head and swivel by his outstretched hands. But the maneuver had
given his partner the edge in speed that he needed.

His leap was timed perfectly. He crashed into me waist high, seizing
me in a viselike grip that didn't lessen any as we hit the ground. The
impact knocked what little wind I had remaining out of my lungs,
leaving me unable to move, and I wondered if my stitches hadn't opened.
The third man was on me in an instant as well, binding my legs with
what felt like tape. It took a little longer before the one who'd
missed his tackle joined in, planting his knee in my back and resuming
his grip on my hair. I felt my arms pulled behind me, where they were
given the same treatment with tape as my legs. Nobody spoke. We were
all too busy puffing and heaving.
Finally the one at my head managed to gasp, "Now, Garnet, we're going
on a trip."

They rolled me over on my back and extended my neck.

Oh, Christ, I thought, this is it.

I knew begging was useless. I had seconds to decide how I would die.
Screaming curses at them? Shutting them out and thinking only of Janet
and Brendan?

The one at my head reached inside his voluminous rain gear. I readied
myself to see him extract the knife.

Instead he pulled out a black case the size of a pen box, and from that
he took a pre filled syringe containing a clear fluid.

"What the hell?" I exclaimed as he snapped the cap off the needle and
pressed its tip into the side of my neck.

"This is midazolam, Garnet, standard dose, and I assure you that I'm as
good at hitting the jugular as you are, but if you struggle while I'm
injecting, and the damn point snaps off, well, you know the
consequences of a two-inch spear floating through your bloodstream."

I felt the sting of the needle as it slipped through my skin. I didn't
try to jerk away, but my thoughts were going through a blender.

Midazolam was a short-acting, rapid-onset benzodiazepine, or
tranquilizer. Was he putting me to sleep before cutting my throat? I
didn't have more than seconds to figure it out I was plummeting into
darkness as swiftly as if I'd been dropped down an elevator shaft. The
last words I heard sounded vaguely like, "MacGregor's going to be
pissed."

"These days he's always pissed," someone replied.

The next thing I remembered was listening to Jack MacGregor arguing
with someone, and thinking that I was back with him during my residency
days in New York.

"Christ, I wanted him cooperative, not comatose, you assholes," he was
saying.
Probably to some junior intern, I thought. Jack rarely lost his
temper, except when the junior interns did something really stupid.

"Now give him more flumazenil," he ordered.

They had to be treating a benzodiazepine overdose. Flumazenil was the
antidote.

"What do you expect. Jack? You can't snatch a person and expect him
to cooperate," someone answered back, far more angrily than was
appropriate for a junior intern addressing his senior.

"You didn't have to jump him with masks on," Jack persisted.

"Oh, yeah? You were the one who insisted he wasn't to be trusted with
a prearranged meet."

"Hey, I didn't say he wouldn't cooperate--" "That's the trouble with
you these days. Jack," interrupted a second voice.

"You've been seeing so many traitors everywhere that none of us is ever
sure which of your alerts are real, but neither can we afford to ignore
them."

"Yeah!" agreed the first speaker, sounding increasingly belligerent.

"We sure as hell couldn't risk letting him see our faces, in case for a
change you were right about not trusting him. Maybe you can fly from
place to place and stay safe, but we have to live here."

"Goddamn it!" Jack snapped.

"You don't think I've got cause to be especially careful?"

"Hey, take it easy, friend," rejoined the second speaker, sounding
hostile and not at all reassuring. He also seemed to have moved closer
to me, and immediately I felt a tingling along my left arm.

"You dare tell me to take it easy?" Jack countered, his tone jarring,
almost whining.

"You've still got a license. I don't."

"For Christ's sake, get hold of yourself " exclaimed a third man. He
spoke firmly, yet not as loudly as the other two, and managed to sound
almost kind.

"We've got less than two weeks to go, and frankly, your drinking isn't
helping--" "Shut up! I'm not so drunk that I can't still do my job,"
Jack yelled back defiantly.

"After all, it's not like I'm still working in ER. You try sitting
around for months on end--" "Jack, do you want to take Brama or not?"
this third speaker interrupted.

"This is your baby more than anyone else's, but so help me, if you
don't smarten up, sober up, and toughen up now, I'll cut you from the
operation myself."

"No!" shrieked my former classmate.

"Nobody's fucking taking that from me, y'unnerstan'! Nobody!"

This wasn't the Jack I knew.

"Shit," the second voice muttered.

"He's not even in good enough shape to debrief Garnet."

Nor was this part of our residency, and that meant we sure as hell
weren't in New York.

The flumazenil hit and catapulted me out of my stupor and into the
middle of a nightmare.

First my eyes flew open, and I saw the hollow-eyed, unshaven face of my
oldest friend staring at me. A garish light from somewhere behind my
head painted his gaunt features in black and white, throwing harsh
silhouettes of him and his three hooded companions, who were also
hovering over me, against the far wall. We were in some kind of car
garage, surrounded by lifts, racks of automotive repair tools, and
loops of chains dangling from hooks high in the ceiling. The elongated
shadows in the place cast everything in duplicate, and it all resembled
a Marquis de Sade playground. I quickly became aware of the grease and
oil smells, and soon realized that the rushing noise in my ears was
actually rain pelting onto what sounded like a metal roof.

"Hi, Garnet," Jack said quietly, pulling up a wooden chair, turning it
around, and straddling it, keeping the back between us.

I simply stared at him, aghast at how skeletal his usual lean, good
looks had become. Only after digesting his appearance for a few
seconds did I try to speak, yet even then I found I couldn't get my
mouth to work. I was also feeling perpetually on the verge of
dizziness, and had the beginning of a headache that kept threatening to
set up residence above my eyes. All, I knew, were effects from the
anesthetic agent.

Glancing down, I noticed that I was propped up in an old car seat, its
upholstery chewed into holes the size of rats.

After several more seconds of experimenting to see what movements my
feet and hands could make--they were no longer taped together--I once
more tried talking. It took a few tries, but this time I finally got
my jaw disengaged enough to slur, "Jack, I swear to God, there better
be a goddamn good reason for this, and even then I may still use your
guts for a bungee cord. What the hell's going on with you anyway? You
look like shit!"

He said nothing at first, then ran a hand over his stubbly face.

"You mean this? Why, it's my new look. Best disguise in the world,
being a homeless drunk." He forced a phony sounding laugh, but the
gathering gloom in his bloodshot eyes belied his attempt at sounding
cocky.

"And sorry about the rough stuff," he added, as breezily as if he were
apologizing for some minor social infraction.

"Since there are warrants out on me, I can't take any chances, but I'm
afraid my men were a bit overzealous."

"My men were a bit overzealous?" I echoed incredulously.

Part of me wanted to laugh, but I was too angry. Somewhere in my
half-anesthetized brain it registered that this was the second time in
two weeks that some idiots had scared the shit out of me in that damn
parking lot.

"Simply saying "Sorry' doesn't begin to cut it with me," I began, my
voice quickly gaining volume.

"And as for your daring to talk to me about not taking chances, you
don't think jumping me like that and shooting me into a coma with
midazolam wasn't a teensy bit chancy?" I was roaring at him now.

"Why the hell didn't you just call me? And what kind of trouble are
you in anyway?"

He flashed me a grin, but there was no merriment in it.

"Hey, Earl, the reason I didn't call is that, frankly, I don't trust
you or anybody else right now. When I talk to people these days it's
face-to-face, so I can see all the little gestures and clues that help
me know who's lying and who isn't. Besides, though I know I'm not on
America's Most Wanted--yet--I still don't give advance notice to anyone
I meet. After skipping bail, failing to appear in court, and crossing
numerous state lines, I'd make a nice small-time catch for any cop who
might get a tip about where I was scheduled to show up."

"Wait a minute. You seriously thought that I'd have turned you over to
the police--" "Don't take it personally, pal, but there's simply too
much at stake for my risking the cops nabbing me. Other doctors that
Brama targeted--some of them calling themselves friends--have been
willing to make deals with the bastards-me and my group in exchange for
their careers. Oh, I didn't think you'd set me up to save your own
skin, but now that they're using Janet to get at you, well, I know
there's nothing you wouldn't do for her."

I couldn't believe what I was hearing--neither the paranoia in the
words nor the resentment in his voice.

"How do you know about Janet?" I demanded.

"And what are you talking about, 'you and your group'?" I glanced at
the other three men, who had withdrawn into the shadows and not said a
word. Did I know them? Were they afraid that I'd recognize them by
their voices in spite of their masks?

"You tell me what we want to know," he continued, "and maybe I'll let
you in on what we're organizing. As for how we found out about Janet,
let's just say we've got friends inside Brama who feed us the names of
doctors who've pissed them off so badly that they've become
undesirables. Then we show up and say, Wannajoin us? That's how we
got the one who stuck you with the needle."

His continuing glibness about the attack irked me.

"Join what? Kidnappers Incorporated? And are you saying one of these
bozos who presumed they had a right to abduct and drug me is a doctor?"
I waved vaguely toward where the trio were standing, and only then did
I notice a small intravenous line and syringe taped to my arm. I went
to reach for it and Jack quickly grabbed my wrist, a whiff of body
odor and alcohol accompanying his sudden movement.

"Not so fast, friend," he cautioned, his grip tightening.

The hint of menace in his voice dismayed me.

"Friend?"

I said incredulously, and met his tormented stare head-on.

"That's right. Jack. You are my oldest friend, and you're frightening
me. Tell me, as one friend to another, how frightened of you should I
be? What are you about to do? Twist my arm? Tie me up again? Maybe
worse? Tell you what. I don't know why you're here or what you're up
to, and I sure as hell don't know who your new buddies are, but I'm
walking away from this place now. Whether you and I can salvage
anything between us after this crap depends solely on your letting me
go--" "Oh, don't give me that holier-than-thou horse shit of yours,
Garnet!" he snarled, shoving me roughly back in my seat.

"First of all, you might need another shot of flumazenil before the
midazolam wears off entirely--I'm friend enough not to risk letting you
leave before it's safe--and secondly, everybody in this room, including
you, wants to see Brama brought down. Isn't that in itself cause
enough for you to stick around and chat?"

His face had turned an ugly shade of crimson as he glared down at me.
My God, I thought, alarmed by his sudden show of temper. Could he
actually turn violent? In all the time I'd known him, I didn't ever
remember seeing his face so livid. I had to get out of there.

As soon as he took his hand off my chest, I defiantly attempted to
stand, but abruptly felt my brain go into a spin cycle, and flopped
back onto the car seat. I spent the next sixty seconds leaning forward
with my head in my hands and trying not to throw up. Above the noise
of the rain overhead I could hear an occasional roll of thunder, and
something else.

At first the sound blended in with the storm, but then I recognized it
had a steady crescendo and fade away that was far too even to be
thunder. It was an airplane--a jet, small, I guessed, by the pitch of
it's engines--passing low above us.

Suddenly I couldn't fight the nausea anymore, and retched loudly, but
nothing came.

"I won't say I told you so," Jack said, his voice jocular.

"Do you want a bucket?" ' His mood swings were making the doctor in me
despair, as they suggested a mind working in fragments, unable to offer
an appropriate affect, or feeling, with any consistency. But I felt so
rotten myself that for the moment I couldn't care about anything except
trying not to throw up.

"I don't think so," I replied weakly, staring at a grease spot on the
floor between my feet and swallowing my spit over and over.

"Anyway," Jack continued, "enough about me. Let's talk about you. And
my my, haven't you become quite the firebrand, old friend, joining the
battle against Brama the way you have. I must say, I liked the
expression 'no-fault murder."

A real grabber, that one. Our group followed your press with
interest..."

As he talked his forced gaiety cut through the spinning in my head and
continued to set off alarm bells. His voice, strained to the point of
sounding brittle, had a desperate edge to it that I'd sometimes heard
in smiling depressives, just before they'd attempted suicide.
Swallowing extra hard, still feeling at risk of vomiting, I looked up,
intending to say something therapeutic, such as, "Cut the crap, Jack!"
But he appeared so agitated, up on his feet now and pacing in front of
me while he ranted, that I held my tongue. Better to handle him with
kid gloves, I decided.

"... we keep track of newspapers, and cases like Robert Delany's.
That's how we find our real soldiers. Of course there are
traitors..."

His unbuttoned raincoat streamed out behind his six-foot frame like a
cape as he strode back and forth. In happier times we might have
laughed about how he cast a huge silhouette resembling a very campy
Count Dracula each time he passed in front of the light. Tonight the
spectacle only added to my sense of disorientation

"... one of our informants in Brama headquarters did me in--after they
caught her sneaking out files. She could save her ass, they told her,
by agreeing to set me up. When she made her next delivery, the cops
were there as soon as I took possession..."

He'd abandoned all pretense at being flippant now and was pouring out
his words, as if he couldn't unburden himself of them fast enough.

"... Now we're willing to go outside the law, and we'll bring Brama
down--" "Wait a minute. Bring Brama down? And that means what,
exactly?" I interjected, startled to hear the threat amidst his
meandering rant.

He abruptly halted, then spent at least a dozen seconds staring at me,
wearing me quizzical look of a man who seemed to need reminding about
why I was there. His three buddies off in me darkness started
exchanging urgent sounding whispers.

Jack ran his hand over his unshaven chin, appeared to collect himself,
and returned to sit once more in the chair before me, this time turning
it the right way around.

"What I need from you. Earl, is information," he implored, leaning
forward.

"It's better for you that I don't explain why." His manner was all at
once as calm and reasonable as if we were discussing a case in ER. This
unexpected return to normalcy was perhaps his most unsettling change so
far. It was as if he'd decided that we'd both simply forget what had
gone before.

"Did a patient from St. Paul's or someone close to a patient kill
Saswald and Forbes?" he bluntly demanded, his voice still quiet, "m
particular, a patient with an alcohol problem?"

My head promptly cleared.

"Pardon?"

"You heard me."

"Why did you ask that?"
He sighed and gave a wave of exasperation.

"I told you that for your own good, I can't give you details."

"Look, Jack, for reasons of confidentiality, I can't tell you who's
involved, but yes, there is a suspect who's got problems with alcohol.
I want to know how you knew to ask."

"Shit!" he exclaimed, creasing his forehead and ignoring my demand.
Off in the dark I heard the outbreak of more excited mutterings.

"Can you give me his name?" he entreated.

"No, of course not. He's my patient, and besides, the police told me
not to discuss anything about the killings, so as not to compromise
their investigation."

He leaned back, opened his arms, and grinned.

"Hey, you know you can tell me," he wheedled, "doctor to doctor."

I felt my anger flash again.

"I don't know shit about you anymore, Jack! I sure as hell don't know
if I can trust you after what was pulled here. One thing I do know is
that I'm not telling you squat until you level with me. And no more
shit about your not telling me for my own good."

He studied me for a few seconds, his scowl darkening.

"Like I said, pal, we have good cause to be wary of you," he declared
softly, his voice hardening.

I bristled.

"That crack you made about me turning you in to save Janet was an
insult!"

"We have other reasons," he coolly replied.

"You've been observed working closely with the detective in charge of
Saswald's and Forbes's murders. That's why we figured you'd know who
the main suspects were, but it could also mean you might be so cozy
with the cops that you'd be a danger to us."

"Observed? Wait a minute! You've been watching me--" "Fuck your
goody-two-shoes outrage, Garnet," he bellowed, jumping up from his
chair and knocking it over.

"We intend to destroy Brama; they intend to stop us; the winner will be
the one who fights dirtiest--it's that simple. I'm not about to let
you or anyone you might talk to screw up what has to be done simply
because you have some selfish, puritanical need to keep your lily-white
hands clean." He paused, his face crimson.

"That's always been your problem. Garnet," he added, "being hung up on
the rules, and frankly, I don't have time for it now. So tell me what
I want to know--who's being investigated for those murders--and then
you can go back to your ER, your wife, and your kid, and let people who
aren 't scared of getting their hands dirty take care ofBrama for
you."

I felt my own cheeks burn. Jack seemed to transform into a stranger
before my very eyes. So Janet had been right about his being jealous
of her after all, I thought sadly, and my take on his accepting my
having a home life over the years had been wrong. What else had I been
mistaken about? More specifically, what was he capable of doing that I
wasn't aware of?

But I had to admit that one thing hadn't changed with Jack Despite
being so distraught, half inebriated, and raving, his criticisms still
had the power to cut me to the bone.

As I sat there trying to compose myself, he stood watching me. Then
his shoulders dropped and his face softened.

"Earl," he said, his voice all at once weary, "have you seen Robert
Delany's parents since the night he died?"

Stunned by his unexpected question and the softness in his voice, I
hesitated, then answered, "No, and even then I'd only met his mother.
Why?"

"How do you think they're handling it?"

I unwillingly thought ofBrendan.

"I think they're probably in hell."

"Are they aware that their boy might have been saved if me mother
hadn't been tricked into waiting?"

I started at the word "tricked." It was brutally more accurate than
anything I'd ever used.

"Yeah, they know."

"Have you had similar cases lately?"

I simply nodded.

"And the people who have tried to get solace or justice through the
legal system, how do you find they cope after the courts have told them
that they've no recourse?"
"Not well," I answered tersely, beginning to grow impatient with his
Q&A routine.

"Now imagine how Robert Delany's mother and father would react if
someone approached them at this moment and offered them a chance to get
even, to get justice, to pull down those most responsible for their
son's death, and prevent such an evil tragedy from ever being inflicted
on other sons."

"Oh, my God! Jack, you didn't?"

He ignored the question.

"Also imagine your other cases like this one added to all the similar
cases of other doctors-not just from your hospital or from your city,
but from the whole country." He paused, then added, "As I said, we
find the more sensational ones through the press, using the Internet to
scan every print media outlet that has a listing, and we study the
numerous websites that are rich with horror stories involving HMOs. But
with Brama we have--or at least had, until I got busted for it--a very
special edge. One of then secretaries--her mother had died from a
heart attack as a result of their triage-two-step--became sympathetic
to our cause and had access to their more sensitive records. Did you
know they actually review the morbidity and mortality figures for
unexpected trips toER following triage advice? It helps them keep
their deterrence of visits at a level sufficient to generate savings
between one and two percent, yet not kill or maim so many as to provoke
too big an outcry for them to keep under control."

"No, I didn't," I admitted, nevertheless taken aback at how close to
the mark my speculation about their motives and tactics had been.

He looked at me, exuding only sadness now.

"That's what we've been doing. Earl, for the last few years, tracking
down and approaching the survivors of people on that list, offering
them proof of why their loved one died, and a chance to do something
about it."

I simply gaped at him.
His revelation, so terrible in its simplicity, yet so logical, and the
sweep of what he intended to do, had staggered me to the point that I
found myself holding my breath.

"Not all of them respond, naturally," he continued, apparently unaware
of the impact he was having on me.

"Some are too numb to do anything; others, by some strength I'll never
possess, are actually managing to cope, but a good half are so racked
with anger, pain, and frustration that they find what we offer them to
be a godsend, sometimes for their very sanity."

I remained too flabbergasted to speak. Finally I was able to ask, "Do
you not realize the emotions you're playing with?"

"Oh, I know, Earl," he replied, his eyes growing dark with
excitement.

"It's a fierce and terrible rage that I'm tapping into. And it's all
going to be directed at Brama. But when they suffer the justice we
intend to bring down on their heads, there won't be an HMO in the
country that'll dare to continue the practices that killed the likes of
Robert Delany, because we'll be there watching them too, gathering
information, and ready to strike."

A cold sweat crept over my skin. His zealotry to engage in such an
odious form of mass manipulation drove a coup de grace to the heart of
whatever I'd once liked in the man. Was this the sales pitch he used
in order to rally his followers and hold them to his purpose? I
wondered. Or once he'd unleashed their fury, did it simply feed and
perpetuate itself, keeping them all at the ready to do his bidding?

I carefully tried to keep all traces of judgment from my voice and
face. If I made him hostile again, he'd clam up and I'd learn nothing
more of what he planned to do.

"How many of these survivors have you recruited?"

"Admittedly it was slow at first," he replied, showing no hesitation.

"But as we got more members, and they in turn fanned out to go after
yet more candidates, soon we were growing with the speed of a chain
letter. After two years' work, we've established chapters all over the
country, and our numbers run in the thousands." Unchecked pride showed
in his face and sounded in his voice.

"Different people want to help in different ways, of course," he
continued without prompting.

"Some provide funds, others who are well-placed in the health care
industry provide us with information, and still others are more prone
to direct action."

This was the opening I was waiting for. As evenly as I could, I asked,
"And what direct action will all these people take?"

In an instant he was as alert as an animal who'd heard the warning snap
of a twig. His eyes flared, he held his head up as if he were sniffing
the air, and the lines in his face once more pinched together,
gathering into a mask of anger and suspicion.

In the silence of his gaze I became aware again of the thunder rumbling
and growling overhead and the rain teeming onto the roof. Once, the
lightning was so close that I actually heard its searing snap, and the
building shook under the impact of the boom that followed on top of it,
but Jack didn't waver from his study of me.

Then he caught me totally off guard, and winked.

For a marvelous moment I saw in his forlorn face and eyes the old fire
from days long ago when we had trained together on the most desperate
patients in ER. That spark, a sign of Jack's own confidence, had
always been there when he'd insisted we not shy away from the worst
lost causes who came through the door. I had teasingly called it his
St. Jude's fire and deemed him patron of the hopeless cases, but in
truth that special glow that suffused him when he took on the
impossible was contagious. Time and time again, when I'd been on the
verge of succumbing to my own feelings of hopelessness and inadequacy,
he'd used it to ignite my own confidence and exhort me to heights of
courage and skill that I'd never known I possessed.

"Well, Garnet," he grinned, "as I keep saying, I can't tell you that,
for your sake and ours, but I promise you, it'll be one hell of a
show."
Before I could protest, the magical moment was gone and his expression
had clouded over again.

"And now, it's your turn to fess up," he told me sternly.

"For our plan to work, there can't be any loose cannons in our group
taking matters into their own hands. That's why I have to know who the
police suspect. If it's anyone from our group, we've got to weed them
out now."

I started to feel ill again.

"Jack--oh my lord--you haven't set up some kind of death squad--" "Of
course not!" he snapped, the hostility in his voice soaring.

"But someone else may have. There's a lot of anger out there, and as
you know, rage can sometimes make people go over the edge. Our
credibility demands no loss of life but our own!"

My state of mind surged toward panic.

"What the hell are you saying?"

"Look, are you going to give me the names I need or not?"

"The answer's no. Jack! I won't! I'd never help you manipulate
people already deranged by grief into doing God knows what. It's
monstrous. You just admitted you can't always control the effects of
that kind of meddling. And what the hell does 'no loss of life but our
own' mean? Some kind of protest involving mass suicide?"

He stared at me, his eyes slowly refilling with a cold, black anger.
But it was his failure to deny any of my charges that really disturbed
me.

"So this has been a total waste of time," he finally declared.

I gathered my strength and stood up. After a few weaves and staggers,
I managed to stay on my feet.

"No, Jack. This hasn't been a waste of time," I said, ripping out the
syringe and IV "This has been an education. You're certifiably out of
your head, a danger to yourself, and from the sounds of it, to a lot of
other innocents as well!"

He spat on the ground between us.

"Fuck you. Garnet!" He pivoted on his heel and strode away.

"You're playing God with other people's lives, Jack!" I bellowed.
Over his shoulder he yelled, "So's Brama, damn you! And you don't
know half of it." He waved the others to follow and headed toward a
door at the far end of the building.

I stumbled after him.

"You're always so righteous. Jack.

Always so sure that you're more on the side of the angels than
everybody else. It makes you blind to means different from your own"
"You're an innocent. Garnet. A useless innocent!" he replied without
breaking stride.

Determined to stop him, I quickened my pace.

"Jack, wait!

I know another way to bring down Brama that's not going to get people
hurt. I think they're into something illegal, and they're scared as
hell I'll find out about it."

He spun around to face me, continuing to back away as he talked.

"Ooooh, I'll bet you've got them trembling in their boots," he
mocked.

"Like I said. Garnet, you don't know half of it," and he turned again
toward the exit, reaching for the door handle. The three other men
were right behind him.

I could barely keep up.

"Damn it. Jack. They have an addiction clinic in Mexico, and I'm sure
we can nail them for whatever they're up to there."

I might have fired a gun in the air. All four men froze. Jack already
had the door open, but shoved it closed again.

I stopped dead in my tracks.

"Shit, he knows!" one of the three men in masks declared.

"No, he just said he thinks they're up to something illegal," Jack
corrected.

"He doesn't know shit. But he could do harm."

The others waited by the door while Jack strode over to where I was
standing.

"Garnet, you leave that clinic alone, you hear me? Take my word for
it, there's no good you can accomplish by poking your nose into their
business, but you could put them on alert if you try. The consequences
could not only be deadly for you, but lethal for a lot of other good
people as well, and there'd be nothing to show for it."

Damn, I was fed up with his elusive talk.
"What are you saying. Jack?" I challenged, hoping to provoke him
into revealing something specific.

"Not five minutes ago you gave the impression that you were setting
your followers up for some sort of noble sacrifice. Are you trying to
tell me now that it's okay for people to die as long as their deaths
help your cause?"

I'd expected him to be furious with my defying him again, given how
he'd been behaving, but his features softened and that terrible sadness
I'd seen earlier flooded into his eyes.

"It's bad that we end this way, Garnet. I know that I'll never
convince you about the righmess of what I'm doing, nor will your
arguments ever persuade me to back off. But maybe I can help you to at
least understand. Remember my favorite book? I used to keep it on my
desk back in our apartment. Revisit it if you can. You might think
kinder of me." He paused, then pointed a finger right between my
eyes.

"But whatever you do. Earl," he uttered, as softly as if he were
speaking a prayer, "heed my warning about the clinic."

With that he turned and was out the door, along with the others.

I didn't run after him this time, knowing it was pointless, just as
he'd said it was. I instead walked over and stood in the exit, feeling
the cool night air laden with rain rush over me.

Outside I could see a floodlit junkyard cluttered with the rusted
remnants of trucks and cars. Nearby I spotted my own vehicle, parked
in the shadow of a huge tree. In the distance, where the front of the
property opened onto a road, I saw the taillights of what must have
been the kidnappers' car flash, then turn right and disappear into the
night. On the other side of the road was a chain-link fence, and
beyond it a darkness broken by lines of runway lights receding into the
distance. I was at the far end of the Buffalo airport.

I stepped outside. The rain was much lighter now, and I found it
refreshing as I walked toward ray car. The keys were in the ignition,
but I didn't feel up to driving just yet, so I strolled the rest of the
way out to the highway. A few flashes of lightning lit up the distant
sky, but they were so far away that now I could barely hear the
thunder.

At the roadside, I stood and watched the rotating beam atop the control
tower about a mile off. A plane was taxiing toward this end of the
field, blinking green and red as it slowly drew near.

Then I spotted him silhouetted in the glare of the plane's landing
lights--a solitary figure running across the field at full speed to
meet it. Instantly I knew it was Jack, by the cape effect of his
raincoat billowing after him. When the plane slowed to turn and face
back up the runway, I could make out that it was a small jet, but
couldn't see the markings. As I watched, a rear door opened on the
side nearest me, out of sight from the tower, and hands reached out to
haul Jack on board. The hatch closed, the engines roared to a
high-pitched whine, and the winking craft sped away. It was airborne
in seconds, and as I stood there staring after its diminishing green
and red flashers, the title of Jack's favorite book popped into my
head. He'd always kept Dickens's Tale of Two Cities on his desk, and
read it whenever he needed to relax.

"Theirs was the perfect friendship," he would say, referring to the
relationship between the two lead characters, Charles Damay and Sydney
Carton. Then he'd add with a laugh, "Just like ours." He'd been
especially fond of the story's closing lines, attributed to Sydney
Carton as he mounted the steps of the guillotine in his friend's place,
and I could recall the sound of Jack's voice when he'd quote them, as
he often had, sometimes facetiously, but always lovingly: "It is afar,
far better thing that I do than I have ever done. It is a far, far
better rest that I go to than I have ever known."

Shit! I thought, feeling I'd been tricked into remembering the words.
Whatever he was up to, had the self-aggrandizing son of a bitch just
tried to glorify his own suicide to me?

As I continued to track the green and red dots moving across the sweep
of black sky, there was another distant flash of lightning, and I
caught sight of the little plane illuminated in its entirety against a
high bank of clouds before the sky returned to darkness. It had been
enough to let me see the red cross insignias on the fuselage. He was
hitching a ride in an emergency air ambulance.

It was a vintage Jack move, and I found myself grinning, in spite of
everything. Those pilots were notorious cowboys who flew in conditions
no one else would consider even remotely safe. And they'd never refuse
a favor to an emergency physician, not even one who was in trouble,
because it was mainly ER doctors upon whom they depended to man their
flights.

The plane seemed to settle into a southwest course before the running
lights winked out for good.

"What have you unleashed, old friend?" I muttered, needing the
reassurance of hearing my own voice.

But all I got for an answer was silence.

I stood a long time staring off in the direction he'd gone, my
questions gathering and expanding, until they seemed as vast as the
night and were as far-reaching as the great distance he was now flying
over.

Perhaps answers couldn't be had here, I finally told myself, and headed
home.
Chapter 16

"Mass suicide! How can you be so sure?" Janet demanded.

"From what he said. From what he didn't say. From the look in his
eye," I replied.

"He was so fragmented there's no one thing I can pinpoint."

Yet by the time I'd driven home from that accursed garage, I'd grown
nearly as certain about what he was up to as if I'd laid out his plans
myself.

"You should have heard him," I continued, "saying things like, "Quite a
show," and "Our credibility demands no loss of life but our own." I've
got to tell you, on the way back here in the car, those words kept
giving me flashes of people strapping themselves with dynamite,
occupying Brama offices all over the country, and, after sending out
the staff, blowing themselves, plus the company, out of existence--all
in the name of lost loved ones."

"Good God, Earl. That's too hideous to consider!"

"Not for him it isn't. Not now. ER was his life. With that gone,
he's got nothing left, except this crusade of his. And if he's as
suicidal as I mink, why wouldn't he sacrifice himself to bring about
Brama's downfall? Look at the allure. He'd be destroying not only the
company's property, but also the reputations ofBaines and his cronies,
probably to the point they couldn't even think of rebuilding. Brama
would probably be out of business for good, and it isn't likely there's
an HMO in the land that would dare ignore a message that brutal. They'd
all change their ways--especially if they feared that Jack had made
good on his threat to leave some of his people behind to 245 serve as
monitors, ready to act again if necessary. Believe me, the idea of his
leaving that kind of legacy would appeal to him."

Janet gave a shudder.

"You make it all sound so effective, but it's madness."

Too damned effective, I thought, to ever expect that I or anyone else
could simply persuade Jack not to put the scheme into play.

"My only hope of making him back off would be to come up with a better
way to get at Brama." Even as I said it, vestiges of a plan to do just
that started popping into my head.

"Hold it, buster," Janet declared, her expression immediately shot full
with fresh alarm.

"All I expect you to 'come up with' is an assault and kidnapping charge
against this socalled friend!" Her voice was shaking. She'd already
been on edge for several hours, having had no idea where I was. My
walking in the door all muddied, bruised, and missing a tuft of hair
hadn't helped her state of mind any. But her continuing to be so upset
now, I suspected, wasn't solely on account of all that had just
happened or what I'd told her, but also because she had no idea what I
might do about any of it. It wasn't that she didn't trust me. But she
had a long held conviction that my so-called friend was the one person
on the planet who could even come close to matching her influence on
me, and in her mind, not always for the better.

Ever since I'd once arrived home driving his Harley, having had no more
training in motorcycle driving than Jack perched on the back yelling
out the occasional instruction, she'd never been entirely sure that I'd
act sensibly whenever he was around.

Except this time I had to admit that she had cause to be worried.

"Earl, we tell Riley!" she insisted when I didn't agree right away.

"Is that understood!" It was an order, not a question.

"Of course we tell Riley," I reassured her, quickly determining the
parts of the story that I'd leave out. They pretty well corresponded
to what I hadn't told Janet--that Jack was using an air ambulance to
move about, and that he may have already tried to recruit Robert
Delany's parents to his cause. I was protecting the pilots because
they probably knew nothing of Jack's plans anyway, and besides, for
what I had in mind, I needed Jack out there, in a position where he
could call off his followers. As for causing the Delanys any more
grief or harassment--that was out of the question.

"But do we have to call the detective now?" I asked, glancing at my
watch. It was after one in the morning, and we were seated at our
kitchen table sipping tea, both of us dressed in bathrobes and nothing
else. Even under the loose white folds, the shape other tall form
easily aroused in me a desire to lose myself in her.

A strand of blond hair fell across suspicious blue eyes as she asked,
"What are you up to, Earl Garnet?"

"Nothing." I grinned, draining my cup and refilling it from the pot
she'd made us. Then I toasted her with it.

"But since we're full of tea, wide-awake, and suitably undressed,
surely we can think of something better to do right now than talk to
the cops."

Janet's frown deepened.

"What aren't you telling me?"

"That you're a beautiful woman, mother of my child, and altogether too
suggestive under that robe for me not to get at least a few ideas."

"You've got to be kidding. After what you've been through?"

"Why not? Nothing like a little terror to fan--" Janet leaned forward
and silenced me with a finger against my lips, then ran it gently over
them.

"Just don't get any crazy, dangerous ideas about trying to save Jack
from himself, Earl. You owe that to me and Brendan. We're the ones
who love and need you." She got up off her chair, took my cup from my
hand, and straddled my groin, letting her robe fall open.

"Now, as you love me. Earl, promise me that," she commanded, reaching
down and gliding me into her, then taking my breath away with a fierce,
hot thrust.

I promised.
* * * I don't know which brought Riley running faster, Janet's promise
of a good breakfast or my informing him over the phone that I'd been
kidnapped. I knew virtually nothing of his personal life, but since he
was the only one who ever answered his phone whenever I called him at
home, I presumed he lived alone.

He arrived by seven, and by seven-thirty had gone through two omelettes
while listening to my story, and was now sitting in our front room with
Janet and me, sipping his third cup of coffee, his pad balanced on one
knee. The morning light streaming through the window behind him was
filtered by the remaining leaves on the trees and filled the room with
the golden colors of late fall. Brendan, having finished his own
breakfast mash, played with some blocks in a patch of sun on the rug
that he always sought out at this hour. Muffy dozed at his side.

I was well into my abridged version of events, telling only what I
wanted the detective to know while leaving out the rest, and leading up
to my pitch for the scheme I had in mind. At the beginning Janet had
monitored my every word, "m case he editorializes," she'd growled at me
as she slipped Riley's first plate of eggs in front of him, but now she
was staring off in the distance, apparently lost in her own thoughts.

Hoping to sell the detective my idea before she could tune back in and
start to protest, I said to him, "Look, surely the real priority now is
to stop Jack before he gets God knows how many people killed. Our best
hope of accomplishing that would be to publicly expose whatever is
going on at the clinic and hopefully bring about the downfall ofBrama
before Jack can act. Then I'm sure he'd stand down--" "Impossible!"
Riley interrupted.

"I told you it's already a jurisdictional quagmire. By the time we get
it sorted out enough to accomplish anything, if we ever do, it'll be
too late."

"But if I went down there, as a private citizen, there's a way I could
get into the place--"
"No!" Janet shrieked.

"No! No! No! Goddamn you. Earl Garnet, you promised me there'd be
none of your going off on some wild-goose chase because of Jack
MacGregor. And you will keep that promise, do you hear me!"

Brendan started to cry at her outburst. Janet scooped him up and
quickly comforted him, while Riley, his muscular jaw hanging totally
slack for one of the few times since I'd known him, gaped at my
normally reserved wife.

"Focus on Jack MacGregor, Detective," she told him coldly.

"That whole spectacle last night, with all his noble talk about 'no
loss of life but our own," might have been a sham to mislead you
through Earl. After all, he admitted they'd apparently spied on my
husband enough to learn that he was working closely with you on the
murder investigation."

Riley shot me an alarmed glance.

"What?" I exclaimed.

"Come off it, Earl," Janet rebuked, continuing to nestle Brendan, who'd
immediately fallen quiet.

"You know he's always been willing to go outside the law while
promoting any cause he thinks worthwhile. You think he'd balk at using
your friendship? He and his group of fanatics might very well be
assassins, trying to find out from you what the police have learned, if
anything, about their activities, and then pretending to abhor the
killings. He'd know you'd report verbatim what they said to Detective
Riley."

"How can you think that about Jack?" I protested.

"He's no killer."

Janet leveled a blue stare at me that could have brought on an ice
age.

"Judging from your description of the shape he's in, I don't think you
can tell anymore what he is."

The normally cozy room suddenly seemed cold.

"And as for you, Detective Riley," she added, pivoting around to give
him his share of the freeze, "if I find out you've so much as discussed
my husband going to Mexico on some seat-of-his-pants investigation,
I'll report you to your superiors for unlawfully enticing a civilian
to engage in an unauthorized police operation in a foreign country."

Riley nervously nicked another glance at me, then hastily pocketed his
notebook and got up to leave.

"Thank you. Dr.

Graceton," he said graciously.

"I agree with you that we should go after Jack MacGregor, first and
foremost."

I suspected he probably would have said anything to get out of there in
one piece at that moment, but his agreeing with Janet, I knew, was
sincere. He'd come to appreciate the soundness of her judgment while
investigating the series of deliberately caused infections that had
closed her former hospital.

Her insights at that time had been closer to the mark than anyone's,
including mine.

"We'll charge MacGregor with kidnapping," he continued, giving her his
warmest of smiles, "and unless I'm mistaken, the FBI will be real
interested in making him answer a whole lot of questions about his
group, the murders, and especially what he knows about the clinic in
Mexico." He then chuckled, and added, "As a result, I can assure you
that we won't be needing your husband's services as some kind of
half-assed foreign agent."

I was pretty shaken when I set out from home for St. Paul's.

You're wrong about him, Janet, I kept reassuring myself as I threaded a
way through the heavy traffic. You have to be.

Surely I couldn't have been fooled to that extent. And no way could
the events of last night have been part of an elaborate ruse. Still,
once she'd set my doubts simmering, I couldn't entirely cool them
down.

I also had other worries. As he left, Riley had indicated that agents
from the FBI might want to interview me themselves.

Accelerating up the ramp to the freeway, I found myself having second
thoughts about my initial impulse to withhold how Jack was traveling
around the country. This time I'd be facing a different league of cop,
and while all I had to do was keep as silent on the matter as I had
with Riley, it was one thing to withhold evidence from the local
police regarding my own kidnapper, and quite another to keep that same
information from the FBI. If they did deem it appropriate to launch
some kind of search for Jack, the prospect of my being found out for
concealing the information, especially if it was after they'd been
watching' train stations, bus terminals, and airports to no avail,
rattled me.

But worse than my getting caught would be if they captured Jack, making
it impossible for him to contact his group and have them back off--if I
could find out Brama's secret and it was devastating enough to shut
them down. During the half hour it took me to creep through the
crowded streets, I kept churning over the details of how I might
penetrate the clinic.

It was halfway through my morning shift in ER when Fosse got me on the
phone.

"Earl, the first installment for our Robert Delany Fund is in the
bank," he told me excitedly.

"You can start using it today.

I've already arranged for an official dedication service at four this
afternoon. The press have been invited, Mr. and Mrs. Delany have
consented to be present, and of course I'd like to have you there as
well."

"How big is the fund?" I asked curtly, unable to keep my foul mood
from sounding in my voice.

"Why, it's a good size," he answered, startled.

"What's the matter? I thought you'd be thrilled."

"Sorry," I quickly apologized.

"It's not been a good day.

What's wrong is that all the HMOs are playing Brama's triage game now,
big-time, and the numbers appear to be growing.

Yesterday alone half a dozen people had to sign themselves out, and
we've had that many again already today--all because they couldn't risk
getting hit with an ER bill. How long can you cover those kinds of
expenses?"

His silence on the line spoke volumes.

"Is Brama leading the pack?" he finally asked.
"No, actually. It's pretty ironic. I haven't been fighting with them
on the phone at all. Maybe our visit yesterday shook them up a bit.
They certainly seem to be behaving themselves, at least for the
moment."

Fosse said nothing for a few seconds.

"Well, that's something," he finally muttered, but he sounded
deflated.

"Maybe the other companies won't be so cocky either, once the negative
publicity part of the program starts nailing them," he reassured.

"And we'll just have to convince our donor to be more generous," he
added before hanging up. Yet the worry in his voice confirmed that the
Robert Delany Fund hadn't been designed to handle what was happening
now.

All the same, cash was cash, and I immediately knew who I wanted to be
the first recipient. I had the clerk get me Maggie's chart and called
her number myself, imagining the toothless grin she'd probably flash
when I told her that she'd not only be admitted and tuned up at our
expense, but would then qualify for a stretch of home care.

An intercept broke in on the line.

"The number you have dialed has been disconnected," intoned the
recorded voice.

I stood with the receiver in my hand, eyeing the number listed as her
next of kin. It was her son in California.

On impulse I dialed it.

I reached her daughter-in-law. The woman told me that her husband,
Maggie's son, was already in Buffalo, settling his mother's affairs.
Maggie had died Sunday night, in her bed.

Riley called half an hour later.

"A buddy of mine at the regional office of the FBI in Niagara Falls has
agreed to drive down and meet with you at one this afternoon."

My stomach squeezed into a ball and unleashed a load of acid.

"I suppose his quick response means their finding MacGregor will be a
big priority for them," I replied, bracing to carry on with my lie of
omission about Jack's travel arrangements.
"Actually, it was my offer to buy takeout that got him moving so fast.
Chinese okay with you?"

I got him to agree on using my office. I'd need all the advantages I
could get to pull off what I intended, and home turf would be clearly
less stressful for me than one of Riley interview rooms in the downtown
branch of the Buffalo police station--a place where the city's really
tough gays got taken for questioning.

By quarter to one I'd cleared my slate of cases and lugged a chair from
the hallway into my office, as was my custom when I expected two
visitors.

Agent Bill Watson was a middle-aged, leanly built man with closely
cropped salt and pepper hair. His dark ebony face easily broke into
laugh lines when he smiled his hello as Riley quickly made the formal
introductions. We then helped the detective lay out a half-dozen
take-out containers on my desk, and soon my small work space was filled
with the aromas of sweet and sour chicken, barbecued ribs, and steamed
vegetables.

Riley had briefed the agent well, so we didn't spend a lot of time
going over old ground. Despite this newcomer's disarmingly easygoing
good humor, I could tell by his questions and comments that his mind
was lightning quick.

"I want to know why you dismissed your wife's allegation that this man
MacGregor could be setting up assassination squads," he demanded
without ceremony at one point.

"Why couldn't he be the one responsible for the deaths ofSaswald and
Forbes?"

"Because Jack's not a killer."

"But your scenario has him enticing possibly hundreds of people to take
their own lives. Isn't that a type of killing?"

"Yes, but from his point of view, giving your life for a good cause
isn't murder; it's a noble sacrifice. And since he's probably
including himself among those who will die, I think he's capable of
rationalizing a mass suicide."

Watson didn't even pause to think over what I'd said, giving me the
impression that he already had his own answers to the questions he was
asking.

"Now, Dr. Garnet, from what you told Detective Riley, these other
three men who actually did the kidnapping were probably locals, and at
least one was a doctor who'd been put on this list of 'undesirables'
that Brama keeps."

I simply nodded, having just taken a mouthful of rice to try to settle
my stomach.

He turned to Riley.

"You've arranged for us to meet Baines at three?" he asked.

While tearing a piece of meat from a rib with his teeth, Riley made
what was clearly an affirmative noise.

"Good," Watson acknowledged at the sound, "and the first order of
business will be to ask him to produce a complete list of these
so-called 'undesirables," not just the ones from Buffalo, but from the
whole country. Since, according to your story. Dr. Garnet,
MacGregor's recruited most of the physicians who have joined his cause
from that group, if we interview them all, we're bound to rattle a few
in his organization enough that they'll admit as much."

"But a lot of innocent doctors have been declared 'undesirables,"

" I exclaimed, completely taken back by the sweep of what he was
proposing, "such as my own wife!"

Watson's gray eyes abruptly shone like gunmetal and his kindly features
hardened.

"Dr. Garnet, the United States government does not tolerate threats of
terrorism in any form, and the Bureau will do whatever is necessary to
bring anyone uttering those threats to justice--whatever their
profession, be it doctor, lawyer, or Indian chief. As for those men
and women who happen to be innocent, they, of course, have nothing to
fear."

I didn't reply, but felt a chill run through me.

He released me from his stare, and once more assumed the demeanor of
someone no more threatening than a crossing guard as he laid out the
rest of what he intended to do.

"I
figure what I'll need next will be harder to obtain, but Baines might
agree with our request for it, if he figures his cooperating will put
an end to MacGregor's army."

"And what could he give you that would accomplish that?"

I asked, my mouth so dry I could barely speak.

"All the names and addresses of the patients whose files were stolen
and passed on to MacGregor," he replied cheerily.

"Right there I figure we'd be on to his biggest source of recruits.

Our questioning them is bound to turn up some of his followers, and
once we have a few, we can probably persuade them to give us the names
of others, who in turn will give us more names still. Now the third
item we'll be taking up with Baines will concern this clandestine
clinic in Mexico which seems to be so central to everything, but even
for us the jurisdictional problems--" "Mr. Watson," I interrupted,
"how long do you think this operation you've just outlined--tracking
down all these people--is going to take?"

He frowned at me, making it clear he didn't appreciate my cutting him
off, then answered, "What with cutbacks and the agents available, maybe
a month or two."

"But Jack's men said it would be less than two weeks before they
launched whatever they're planning."

His sudden smile was condescending, and a quiver away from becoming a
smirk.

"Of course we'll be advising Brama officials to up security at all
their offices," he told me with barely disguised impatience.

"If MacGregor's bunch do strike before we hunt down their members,
we'll be ready. Actually, that might be the easiest way to tie up this
problem. I agree with your hypothesis about how they might
attack--individuals or small groups making a simultaneous move against
Brama facilities all over the country. Hopefully they'll try to carry
out MacGregor's promise that there be no loss of life but their own,
and give people in the buildings a chance to get clear. We can use
that time to demand they surrender, or take them out before they
detonate whatever device they're carrying. Now, back to the question
of the clinic in Mexico--"
"But they won't surrender," I protested.

"They're all suicidal."

This time he outright scowled.

"Look, Doctor, we're on a tight schedule. I've tried to inform you how
we intend to act on the information you've provided out of courtesy,
not because I'm prepared in any way to discuss Bureau strategy with
you, and certainly not because I need your permission to carry out what
needs doing. Now I only have one more question, and then Detective
Riley and I can move on. Did your friend MacGregor let slip how he was
flying around the country--which airline he was using or what name he
was traveling under? We already know the commercial carriers have no
record of him."

I was so staggered by everything else he'd said that I blurted out the
truth with no hesitation whatsoever.

"Jack never said a word about any of that to me."

"This helpless toddler's name will become a rallying cry in our
institution," Fosse proclaimed loudly, "as all of us come to use the
Robert Delany Fund to redress the excesses of what managed care has
become today. I call on all of you who work in Emergency to use it
like a sword of justice against those who would visit such wrongs on
the sick at their weakest and frailest hour..."

He was in full flight--eyes flashing, voice crackling with
eagerness--but as noble as his purpose was, I found his words
embarrassingly bombastic. He was holding the dedication in the waiting
room of ER, and while my own staff were obviously delighted at being
handed such an innovative weapon, however short-lived it might turn out
to be, I found myself watching the Delanys, and flinching.

I was sure Mrs. Delany was on some sort of antidepressant

Her countenance was dazed, and while she appeared to approve of the
proceedings--nodding repeatedly at Fosse's rhetoric--when she looked
around the room, her dull eyes and placid expression seemed to float
over the crowd, as if disconnected from what was going on. But it was
her husband's painful appearance that I found more troubling. His eyes
were darkened and hollowed by lack of sleep, his cheeks deeply sunken
from not eating, and his face possessed of a punched-out quality that I
doubted any medication could re sculpt

Even more discomforting was how he otherwise showed no trace of
emotion, standing rigid, staring into space, and keeping his grief
securely locked within him--where it could eat him alive.

He'd need help, some sort of grief counseling, the doctor in me noted,
while in my heart I cringed at the thought of ever having to endure
such agony myself.

Mercifully, Fosse's speech was as short as it was overblown, and the
ceremony was over in less than five minutes.

As reporters bombarded him with questions about whether he was
declaring war on managed care, I walked over to the Delanys and once
more offered my condolences.

"Thank you for coming." Mrs. Delany smiled, shaking my hand. Her
stare was so blank and her voice so flat that I wasn't sure at first if
she even knew who I was. But then she turned to her husband, who'd
remained unflinching at her side, his arms still as rigid as a
sentinel's.

"This is Dr. Garnet, dear, who I told you was so kind that night."

Her calling attention to me was more than he could manage. He looked
into my face like a man awakening from a dream, and his wan features
crumpled up like a used tissue as he let out a huge sob. Doubling
over, he clasped his head in his hands, then, in slow motion, buckled
at the knees until he was on the floor. After struggling to breathe in
again, he emitted a bloodcurdling wail that silenced the room. With
his wife kneeling at his side, her vacuous expression now shattered
with alarm, and me crouched over him with my hands around his
shoulders, he continued to cry, his face pressed to the floor, his body
racked by each convulsive catch of his breath. No one else moved or
uttered a sound. Even the reporters, normally ready to leap on such
scenes, were too shocked to react. It took at least ten seconds before
the first flash went off.

In the end it was Robert Delany Sr's display of agony that persuaded me
to go. Or rather, it made me accept what I'd probably known all
along--that I couldn't not go. And once I'd resigned myself, the
consequences--defying Janet, acting behind Riley's and the FBI's back,
ignoring even Jack's warning to stay away--seemed but painful yet
necessary steps that I'd have to take in order to get the job done.

I turned to the one person who I knew would have the nerve to help
me.
Chapter 17

"I think we're ready." Fosse beamed, grinning mischievously as he hung
up his phone. He'd been talking with his counterpart, a Mr. Brad
Parker, at City Hospital in New York, my, and Jack's, old stomping
ground.

"Calling in a few favors" was how Fosse had put it. In the last three
hours he'd also made contact with the CEOs of several other hospitals
in that area. He'd always been immediately put through, always
addressed them by their first names, and inevitably had gotten the
special cooperation we needed. I knew the man was known for having
extensive contacts in the health care network, but it was impressive
nevertheless to witness his putting those contacts to use.

"Parker's personal secretary will route us through her switchboard," he
continued, "and any number-display device they may have on the Mexican
end of the call will show the New York exchange for City Hospital. The
only physician around your age with blue eyes who's leaving on vacation
within the next few days is a urologist. Dr. Arthur Kane. Now, I
figured you knew enough about the emergency end of his field to talk
the lingo if it came to that, so I said that he'd do fine." Posse
shoved a pad at me where he'd scribbled down the man's birth date,
mother's maiden name, street address, and a number of other personal
details that I might have to provide off the cuff.

"Kane's sending you his birth certificate and a few other pieces of non
photo ID--his urology association card, state physician's license,
automobile association, that 259 kind of thing--by courier for
delivery to this office tomorrow morning. In case anyone in Mexico
tries to call Kane's home or office to double-check his whereabouts,
his answering service will state only that he's on vacation. He said
it was an honor to lend his name to any venture aimed at taking Brama
down a peg."

As had several psychiatrists and directors of labs at the other
hospitals he'd contacted.

Fosse then glanced at his watch.

"It's six-thirty. That means three-thirty at the clinic. Since it's
Friday, if you think you're ready, I suggest we phone them now and set
things in motion before that psychiatrist, Martinez, and anyone else
that matters, goes home for the weekend. Otherwise we're liable to be
stuck until Monday."

We'd already gone over in detail what we were going to say in our
respective roles. I glanced at the scrap of paper that held all I knew
about the man whose identity I was about to usurp and drastically
alter. It was precious little, but probably enough for this first
contact. If they asked me any other easily verifiable facts that I
didn't have, I figured I could slip into the kind of belligerent
paranoia alcoholics so often display, and loudly demand, What do you
want to know that for?

I nodded for Fosse to proceed, took a few deep breaths, and, while he
was being put through, waited for my cue to become Dr. Arthur Kane,
longstanding alcoholic who was willing to pay any price for one last
chance.

Fosse began, "Hello, this is Brad Parker, CEO of City Hospital in New
York calling. I'd like to speak with Dr. Martinez, please." After
listening a few seconds, he declared, "No, he can't phone me back. It's
urgent that I speak with him now."

There was another pause, then he added, "Thank you," and mouthed to me
that they were getting him. As we waited in silence he doodled on his
pad for what seemed about a minute.

Then he sat at attention.

"Dr. Martinez, how kind of you to speak with me. My name is Parker,
and I need your help with a delicate matter regarding one of my staff
at City Hospital, a Dr. Arthur Kane, who's also a family friend..."

As Fosse settled into his part, I found myself thinking about the
problems we'd anticipated, and worrying whether the precautions we'd
taken would be enough. The first difficulty would be if Martinez tried
to verify that he'd actually been talking with the CEO of City Hospital
in New York.

Parker's personal secretary was supposed to field any such attempts and
if necessary contact Fosse. But what if the psychiatrist got someone
else to direct dial Brad Parker's office and request to speak with him
under false pretenses, then listened in on the real CEO's voice?

"... Dr. Kane has run around to various hospitals, but attempts to
treat him have been sporadic and unsuccessful. He even tried one of
the new anti craving drugs, but it didn't work. One of the last
psychiatrists who attempted to help him had made contact with a Dr.
Peter Forbes about the possibility of sending Dr. K-ane to your
clinic--apparently, word is getting out about the remarkable results
you're getting--but we've just heard of Dr. Forbes's tragic death.. "
Fosse and I had taken advantage of the tendency for physicians not to
seek help, or, if they did, to do it sporadically, and we'd created a
confused medical record that wouldn't be easy to check out--but not
impossible. Once Fosse had paved the way with their respective CEOs,
I'd actually asked the psychiatrists at the various institutions to
create a file, assigning them each a fragment of Arthur KLane's
history. I'd then spoken to their respective lab directors, indicating
what blood results I'd need from each of them to create the overall
biochemical picture of an alcoholic who was engaging in ever more
frequent episodes of hinge drinking. But would the fabrication stand
up if Martinez contacted any of these people and questioned them in
person?

"... Dr. Forbes had given this psychiatrist your number, saying you
might want to make a special arrangement for Dr.
Kane. You see, he'd prefer to pay cash, so there's no record of his
condition being so severe he couldn't lick it on his own..."

The most important piece of our plan relied upon their greed. Both
Fosse and I agreed that we should mention money as often as we could.

"... Yes, I understand. I'm sure that that price and those
arrangements would be most satisfactory. In fact, I happen to have Dr.
Kane here with me, should you wish to speak with him. Let me put him
on."

Fosse handed me the receiver and made a thumbs-up sign.

I was on.

"Hello, Dr. Martinez," I began, talking fast. I also shook my free
arm. rapidly back and forth, to transmit a hint of tremor to my voice.
I'd decided to play Arthur Kane as a man who wasn't falling-down drunk,
but was keeping one swig ahead of the DTs.

"Please, you've got to help me. I'll pay anything you ask. My job, my
family, I'll lose it all this time--" "Easy, Dr. Kane. Of course we
will try to help you," Dr.

Martinez said, with the perfect syntax typical of those who have
mastered English as a second language. What little traces of a Spanish
accent remained served only to make him sound suave.

"But please understand, ours is as yet an experimental program. There
are certain releases you will have to sign, and an agreement of
absolute silence on your part regarding what you will experience here
is mandatory, to protect against anyone stealing our methods before we
publish them. We make it clear from the outset that we would impose
very heavy financial penalties on anyone who violated this agreement.
I'm sure, as a physician, you can understand our need for such strict
secrecy to prevent plagiarism."

"Yes, yes, I understand!" I exclaimed, making myself sound impatient
with such details.

"Will you take me?"

"The final issue is one of finances," he went on, ignoring my
question.
"As I told your CEO, we sometimes do make special arrangements for
certain upscale clients. And as I also told him, the fee for such
consideration is fifteen thousand U.S.--a cashier's check made out to
the clinic for five thousand to be sent immediately to us by courier,
as a deposit, and ten thousand in cash that you will deliver to me and
me alone on your arrival. And you are not to discuss these terms with
anyone else who is here. Is that clear?"

"Yes, I say nothing to anyone, while giving the cash to you and you
alone," I replied for Fosse's benefit. He rolled his eyes at the
ceiling, then gave me two thumbs up.

"One other thing," Martinez continued.

"You must be detoxed before you come. How long do you think that will
take?"

This was a standard requirement of addiction treatment centers, and I'd
been counting on it being enforced. While it was possible for me to
imitate over the phone a man who was about to go into a state of
delirium tremens, all the accompanying physiologic changes--sweating,
rapid pulse, metabolic acidosis--couldn't be faked. When I did finally
stand in front of them, I intended to be simulating a patient in a
weakened, post withdrawal state--a condition that had no telltale
clinical signs.

"No problem. I'm checking myself into the hospital tonight," I
declared, trying my best to mimic the overly sincere urgency that most
drinkers used when declaring their good intentions.

"I should be straight enough to travel by Tuesday morning."

"Fine," he said coolly.

"We'll need your medical file attesting to this, along with all your
past records. Call me when you've confirmed your travel arrangements.
Will you be renting a car?"

"No, my permit's been revoked," I told him, attempting to sound morose.
The scenario I'd prepared avoided above all my needing a driver's
license, or any other identification with a picture on it.
"Ah, yes, I understand. Then plan to arrive in Tijuana well before
three p.m. That's when the last bus leaves for our region--the nearest
village is called La Rumorosa. By the way, no cellular, or we'll
confiscate it, and dress warmly.

We're in the mountains, and this time of year you can get caught in a
freak snow squall. Just last weekend six migrant workers froze to
death trying to cross over into your country from here." He hung up
before I could reply.

I looked across at Fosse.

"I'm in," I said in disbelief.

"What's 'in' is the cash," Fosse replied with a sarcastic laugh, "and
from the way he had his price ready, plus the instructions--could you
believe that 'deliver it to me and only me' shit?--I suspect he makes
it a habit to accept special 'upscale clients." Hell, I bet he pockets
the ten grand portion without anyone else knowing."

"Sounds like it. Still, it seemed mighty easy to get accepted."

Fosse shrugged.

"He obviously wanted the money."

"But he didn't even ask me my mother's maiden name."

When I came down to breakfast the next morning, I found Janet at the
table sipping coffee. Beside her was the Saturday paper, and on the
front page I could see the photo of Robert Delany's father huddled on
the floor, with his wife and myself trying to comfort him. bereaved
father collapses at memorial for infant son was the headline. Under
it, in bold print, was the statement ceo at st. paul's indicts
triage

PRACTICES OF MANAGED CARE.

I poured myself a coffee and sat down opposite her, taking my cue to
say nothing from Janet's own silence. She hadn't even acknowledged my
coming into the room. The evening before she'd also not said much, but
it had been a frostier quiet than the thoughtful stillness she now
seemed lost in, and I hadn't dared to even mention Mexico.

"It's not because of Jack that you want to go," she said absently,
sounding as if she was thinking out loud more than talking to me. She
glanced toward the picture.
"But because of him, and what he's lost," she continued, lifting her
blue stare to catch me full in its clear light, "and for others like
him, isn't it?"

I nodded.

"Because you think there's a chance that you can keep the ones whom
Jack recruited from destroying themselves," she declared softly.

"Yeah, I do," I answered.

She continued to study me, her finely etched features making her seem
as fragile as porcelain.

"You know I've every right to expect that you'd chose Brendan and me
over Jack MacGregor," she asserted.

I nodded again, and added, "As you said, it isn't about that."

"You've already decided?"

"Yes, I have."

"When will you leave?" she demanded, sitting a little straighter and
brusquely wiping away a strand of blond hair that had strayed across
her forehead.

"Tuesday morning." I'd bought my tickets to L.A. on the way home last
night.

She started as if I'd slapped her.

"What were you going to do, leave me a note?" she snapped, her lips
hesitating between being pursed into a thin hard line and remaining
open, full, and soft.

"Janet, don't," I said, quickly moving around the end of the table and
sitting beside her. She turned her head away and stiffened when I
tried to pull her to me. Then she seemed to slump in my arms.

"Damn you. Earl Garnet," she muttered.

"I know you're right, but damn you."

We sat there awhile, neither of us saying anything, until Janet asked,
"What exactly are you planning to do?"

I began explaining what Fosse and I had set up, immediately generating
another hurt outburst followed by a barrage of questions about what I
intended. As I answered those, there were even more queries, until
before long she'd gotten a pad of paper and shoved it, with a pen, in
front of me. She tapped it with her finger, looking every bit the
angry schoolmarm.

"I

want to know your plan, every item of it, in writing," she declared.

"Then you and I are going over it, again and again. It doesn't
surprise me that Fosse helped you--he's always been a zealot if he
thinks the cause is right--but he's a little too ready to take risks
for my liking. If you are going to stick your nose into
God-knows-what, I'll be damned if it will be with some half-baked
scheme that I haven't checked out every which way, including sideways.
Now let's get busy."

Soon the anxiety in her eyes and her hurt expression evolved into the
familiar focused look her face assumed whenever she brought her fierce
intellect to bear on a problem. We worked side by side well into the
morning, itemizing all the preparations and contingency plans that we
still had to make. By the time Janet got through adding on what she
considered I'd overlooked, it was a very long list.

Around noon Fosse called to say that all the documents we needed had
arrived from New York.

"By the way," he added, "that Martinez was a lot more cautious, and
trickier, than we thought. He waited until after hours to phone City
Hospital back, and requested that the switchboard put him through to
Brad Barker's home. Fortunately, Parker had warned his wife to take a
message should any calls for him come in from Mexico, but it was a
close shave."

"You didn't call Martinez from a Buffalo exchange, did you?" I blurted
out, alarmed that we might have made our first slipup.

"No," Fosse quickly reassured me.

"Parker left orders with his hospital operators that they're to still
forward any of my long distance replies."

I felt myself relax a bit, but remained on edge about how easily our
whole scam could go wrong.
"What did he say he wanted?" I asked, curious about how clever the
greedy psychiatrist really was.

"Something he'd obviously trumped up. He claimed he'd forgotten to ask
you if you had a history of heart problems."

I never could lie Outright worth a damn--my eyes always shifted or my
voice went up half an octave and gave me away.

So I was surprised at how well I'd been lying by omission to Riley so
far. In fact I was finding the practice not much different from my
keeping medical confidences, and I figured when I next talked to him,
that more of the same would suffice to conceal my plans for Mexico.

He called later that afternoon.

"Baines half cooperated with Watson," the detective announced without
preamble.

"First, as CEO, he readily agreed to have his San Francisco office
provide the FBI with a list of all the patients whose files MacGregor
stole and to immediately step up security at all the Brama regional
offices. But he denied outright that there even was a list of
'undesirables," and when the clinic came up, then he raised the issue
of medical confidentiality to justify not talking about it."

"Has Watson changed his plan any?"

"Not substantially. He's surprised that he got the patients' names so
easily, but now that he has them, he's more convinced than ever that
the surest way of putting MacGregor's army out of commission for good
is to track all those people down. And with so many potential leads in
hand, he's not even that upset at Baines's denying him the
'undesirables."

Certainly nothing's changed with regard to his decision that it'll be
Brama's private security forces which will meet any immediate attack,
and that the Bureau will then back them up with lethal force, if
necessary. About the clinic business, he figures we've got enough to
focus on, and he's letting it drop, for the moment."

I suppose part of me was still faintly hoping that Watson, having seen
the error of his ways, would already be hastily pulling the
international strings necessary to raid the place and make his own
attempt at exposing Brama's secret in time to stop Jack. But on
hearing that the agent's thinking had hardened in exactly the opposite
direction, I abandoned any illusions that I'd get a last minute
reprieve from doing the job myself.

"And what do you think of that strategy?" I asked softly.

"It's a textbook response to terrorists," Riley replied in a flat tone
that gave no inkling of how he was taking the prospect that so many
people would die.

"Even our own tactical manual says contain them, confront them, and if
they don't surrender, shoot them."

When, years ago, Riley had been the only cop who would listen to me
about who had killed our former CEO, I'd also learned something not so
noble about the man--his reluctance to suffer the political
consequences of speaking out against his bosses--and had nearly lost my
life in the process.

As soon as I sensed he was yet again retreating into that same peculiar
passivity, I felt angry, frustrated, and once more let down. Yet
instead of challenging him to do better--my previous attempt two years
ago had gotten nowhere--I found myself sadly writing off his chances of
ever being secure enough to act differently. The bitter truth of the
matter was that the detective, despite his tenacious ness in the field,
simply wouldn't commit the heresy of telling an FBI agent, even one who
was a friend, that in this case their tried and true methods of dealing
with terrorists were wrong.

When I didn't comment right away, he sent a heavy sigh through the
line.

"I'll keep you posted next week about what's happening," he quickly
offered, probably because he knew damn well what I thought of his
refusal to speak out and was trying to make amends.

But I wasn't in the mood to let him. Even though his failure of
courage occurred away from the mean streets and in the domains of
bureaucracy, it could still have lethal consequences.
"Sure, Riley, you do that. I'll be in ERas usual," I told him coldly,
my voice remaining smooth as ice, and, if he'd been able to see me,
without so much as a flicker of my eyes.
Chapter 18

The bus emerged from a thick gray mist into a burst of golden sunlight.
Up ahead, against a darkening eastern sky, I could see the craggy, high
summit ridges of the coastal range where La Rumorosa was located.
Behind them, as if behind a jagged wall, loomed towering storm clouds
the color of eggplants.

"Get off at the clinic road--about a mile before the village.

The driver will know the spot," Martinez had instructed me.

"There's a phone booth there. Call me when you arrive, and I'll fetch
you myself. We're about two miles away, due north, near the American
border."

I indicated the stop I wanted; luckily for me the word for clinic in
Spanish was clinica.

"Gracias," I called back to the man at the wheel as I stepped onto the
gravel shoulder of the road. The blast of cold wind that whipped my
raincoat was more what I'd expect in Buffalo than in Mexico.

"De nada," he replied, closing the doors and releasing the brakes. A
loud hiss nearly drowned out his cry of "Hasta luego!" and the vehicle
lumbered away, leaving me in a cloud of fumes that quickly blew off.

The steep crest of the mountains rose another four hundred feet above
me--the bus had already climbed four thousand since leaving
Tijuana--and the thunderheads I'd seen before were still massing.
Directly overhead, however, it remained clear blue, and to the west a
span of overcast sky the color of 270 lead stretched into the
distance, until it met a thin molten streak blazed across the horizon.
At my feet the landscape sloped away from me, gilded but not warmed in
the dying moments of a late-afternoon sun slipping beneath the cloud
cover and vanishing into that same crimson line. In the foreground,
lakes of fog filled the numerous hollows and twisting deep gulches that
we'd passed on the way up. Scattered among these were dark bluish
stands of giant conifers--evergreens on steroids, had been my first
impression as we'd driven through them--alongside groves of deciduous
trees--all of them wind-lashed.

I walked across the highway to the phone booth that stood like an
abandoned sentry box at the mouth of a dirt road.

Apart from a string of hydroelectrical poles running in each direction,
there wasn't another man-made structure in sight.

"I'll be there to get you in ten minutes," declared a cheery Martinez
when I called.

I spent the time huddled in the glass box, feeling the bite of cold air
as it whistled around my ankles. Outside it was blowing with enough
force to surround me with a mournful howling and send a nearby grove of
trees into a tossing frenzy.

From beyond the ridge above came erratic nickers of lightning followed
by a low rising rumble. The sound echoed off the surrounding rock
formations and was still going on when the next set of flashes
occurred. The incessant growls made it easy to imagine this place as
the origin of mythic tales involving great beasts prowling hungrily
just over the rise and out of sight.

I pulled out a flask of whiskey that I'd bought in Tijuana and took a
mouthful, swishing my mouth with it before letting the amber liquid
dribble down my chin onto my clothes. I knew from years of watching
alcoholics leave ER for rehab centers that it would have been outright
peculiar for Arthur Kane not to have tried giving himself a bracer. And
I needed to have more than whiskey just being on my breath. In case
the clinic had a blood lab, I wanted at least enough in my system to
register an alcohol level, and had been sipping it since I'd gotten on
the bus. Twenty minutes earlier I'd also swallowed a niacin pill to
help Arthur Kane really get a glow on. Over the years, whenever a
patient complained of unexplained flushing, that over-the-counter
vitamin supplement was often the culprit. It causes the blood vessels
to dilate, and already I was feeling my cheeks growing warm as it took
effect.

Martinez arrived in a flashy, black Japanese four-by-four, which I knew
from having priced one in Buffalo--before rejecting it as far too
expensive--cost over $65,000. The tall man who uncoiled himself from
the leather-lined driver's seat looked approximately my height and age,
but there the similarities ended. He wore a beige full-length coat
which I suspected was cashmere. When it caught the wind and flapped
open, immaculately pressed tanned slacks and a navy blazer caught my
eye. He flashed me a brilliant smile that was all the more dazzling
set off by his bronze face and black mustache.

His teeth were too perfect not to have had a lot of help from his
dentist, and I suspected his jet-black hair came from a bottle. If I
threw in the sparkling diamond that adorned the hand he extended to me,
my first glimpse of the man had taken in about a hundred grand worth of
personal wealth.

"Dr. Kane," he greeted me warmly as I stepped out of my shelter.

"Come, let's get you out of the cold." He took my valise and
accompanied me around to the passenger side.

"Why, thank you. Dr. Martinez," I said far too effusively to be
appropriate. I made sure I was close enough that he could smell my
breath.

After he threw my bag in the backseat, he waited until I was halfway in
the passenger door before he quickly reached inside my breast pocket
and relieved me of the mickey.

He cocked an eyebrow at my choice of beverage--it wasn't expensive--but
instead of throwing it away, he smiled kindly, saying, "This will do
perfectly for your treatment," and slipped it into his own coat.
I rode in silence, attempting to re-create the withdrawn quietness I'd
often observed in alcoholics who'd recently dried out. About five
minutes into the drive Martinez gestured at a rise about half a mile
ahead.

"That's our pride and joy," he said.

I leaned forward and caught sight of a long, curved, three story
structure with oversized windows, rose-colored stone walls, and a
red-tiled roof. The building was perched upon a soaring outcrop of
stone at an elevation high enough to still catch the dying light.

"It's beautiful!" I gasped, finding it resembled more a villa than any
clinic I'd ever seen.

"That's the benefit of starting from scratch outside established, and
therefore old, American institutions," he enthused.

"We can offer a setting that's physically designed to engender a sense
of well-being in our patients as opposed to simply housing the
facilities for our clinical program." He sounded like a brochure for
the place.

Still, I saw an opening.

"I must say, I'm intrigued to know what that clinical program of yours
is. From the rumors that I've heard around New York, your results here
are rapidly becoming the talk of the health profession."

He gave a start.

"Rumors?" he said, his easy charm vanishing and his face clouding
over.

"What kind of rumors?"

Easy, Garnet, I cautioned myself, reel him in slowly, and don't spook
him by saying too much.

"That you're on the cutting edge of treating alcoholism; that you're
the first people in fifty years to clearly improve on the current ways
of keeping drunks like me dry." I paused, to see how he reacted to the
praise. Even if his group hadn't achieved the results that Fosse and I
had surmised, I doubted that the ego of the man at my side, given all
the trappings he'd adorned himself with, could resist hearing that he
was the object of such tributes.

And if I whetted his appetite for compliments enough, I figured, maybe
I could make him boast a bit about exactly what it was that he did
here.

The look of alarm that had seized his face drained away.
"Oh?" he said simply, giving me the distinct impression that he'd
love to hear more, yet he remained silent.

Perhaps if I assured him that the details of his secret remained safe,
I thought, despite all of New York pitching him accolades, he'd open
up.

"I'll say this about your security, though--it's airtight," I began.

"No one who I've talked to, not even the psychiatrist who recommended
your place to me, had a clue about your breakthrough. What have you
discovered anyway, a wonder drug?"

His smile reappeared like a sun sliding out from behind a passing
cloud.

"Patience, Dr. Kane, patience. We'll get you settled, give you
supper, and then I personally will do your admission physical. After
that, later this evening, we may have a chat about what we have in
store for you."

Figuring I'd primed him to spill the information I needed as best I
could for the moment, I again retreated into my pose of being
withdrawn, not wanting to risk any unnecessary small talk by which I
might trip up and give myself away.

The road climbed steadily, emerging from a grove of trees and curving
along a steep drop-off. I found myself peering over gravel edges, and
at the bottom of what seemed a five hundred-foot gorge spotted the
rusted remains of a pickup truck that must have skidded off the road
long ago. As we wound back and forth over a series of switchbacks
above the site, the crushed frame remained in view, serving as a grim
reminder that if it did snow up here, driving back down, even with
four-wheel drive, would be treacherous. We then continued upward on a
straight stretch covered in asphalt, the vehicle swaying under the
merciless bombardment of the wind, and the thunder continuing in the
distance like a kettledrum solo.

"Do you know what La Rumorosa means. Dr. Kane?"

Martinez called out happily over the sound.

"I have no idea."

"A loud, noisy rumbling."
When we got closer to the clinic, I was surprised to see that behind
its frontal facade, parts of the place toward the rear were still under
construction. The entire right wing at the back was largely a frame of
timbers, and the rear walls on the left, although completely erected,
hadn't yet received their outer coat of stucco. Like a movie set, was
what came to mind.

"As you can see, we're in the process of finishing the building,"
Martinez said as he swung into the parking lot and saw me looking at
the uncompleted sections. He pulled into a slot with his name on the
curb.

Except something didn't jibe. Even though it was after five and the
workers would normally have gone home, there were no overturned
wheelbarrows, bags of cement, or shovels lying about. In fact, I
didn't see any supplies at all--no lumber, no piles of sand, not even
scaffolding--to indicate that people would be resuming work tomorrow or
any time soon.

The site simply looked abandoned. A sudden lack of cash flow? Or
perhaps all the questions I'd been asking about the place had rattled
Baines even more than I thought, and he was having second thoughts
about continuing whatever they'd started here. Well well, I thought,
pleased at the prospect of having troubled him to that extent.

"Uh, Dr. Kane, about our agreed-upon terms," Martinez said,
interrupting my reverie, "I take it you have the money with you."

"It's in my case," I replied, "as you requested."

Fosse had provided the cash from the Robert Delany Fund.

"We're doing something that is certainly within the spirit of the
endowment," he'd insisted as I'd stored the bills in my carry-on bag.
I'd never let it away from my side since leaving Buffalo.

"Perhaps I should take it here," Martinez continued, "before we go in,
so as to keep our business arrangements private from the rest of the
staff and patients."

Just like a whore, I thought, getting your payment up front.
Except in this instance I'm probably the one who's going to get
fucked.

Hiding my disdain with the greatest of difficulty, I affably replied,
"Of course," and reached to get him his money. He beamed effusively as
we completed our transaction, making it even seedier. He then locked
the stack of bills in his glove compartment and set his antitheft
alarm. Given the total desolation of where we were, I figured the
precautions were to avoid being robbed by the people inside his place
of work.

As I climbed out I noticed that the car beside us, in the place marked
ceo, was a new-looking green Mercedes. By contrast, the other dozen or
so vehicles looked run-down and could be only described as early
American. They all had Mexican license plates, and I presumed belonged
to the clinic's staff.

Huddled against the wind, I followed Martinez up what looked like a
recently laid sidewalk. The black earth on either side was level, as
if it had once been made ready for sod, but it now hosted a growth of
weeds instead.

I waited at his side while he rang the buzzer on a massive white,
windowless door. From a distance I'd assumed it was made of wood;
standing this close I could see that it was metal.

Above me a security camera whirred as it swiveled around to point at
us, the door handle emitted a harsh buzzing noise followed by a loud
click, and we were inside.

"State-of-the-art security," the psychiatrist crowed as the heavy
barrier clanged shut behind us.

"We run the place on a locked-ward principle, given the nature of our
clients, and we've never had anyone escape yet."

We headed off down a pristine white corridor with a gleaming black and
white linoleum floor. A pair of security guards at a control console
filled with video screens greeted Martinez with polite smiles. Less
friendly looking were the revolvers bolstered on their belts.

The result ofBaines ordering beefed-up security even here?
1 wondered. It made sense, especially if the FBI had passed on my
report of Jack's special interest in the place.

Martinez cheerily pointed out the various rooms we passed-his offices,
an adjacent examining cubicle, a classroom, a nursing station, a small
laboratory.

"For doing basic hematology and biochemistry workups, including blood
alcohol levels," he informed me. It was all standard fare for a rehab
center. Except when several ladies in crisp white uniforms swept by
and showed Martinez a bowing deference that American doctors hadn't
seen from nurses since the fifties.

Next we visited a modestly equipped, six-bed infirmary, "Where anyone
who came down with an acute illness during their stay would be cared
for," he assured me. My cursory look at their medication supply told
me they had the standard agents used for cardiac, respiratory, and
gastrointestinal emergencies, but their antibiotics included none of
the more recent-generation drugs. I then got a peek into the dining
room--a large spartan area with wooden tables and benches where half a
dozen men sat glumly eating their evening meal.

After following him up a few flights of stairs, I was shown the common
washroom facilities, including showers. I finished my tour by being
ushered into my room, a windowless cubicle with a simple metal bed, a
nightstand, and a small bathroom.

The harsh contrast between these jail-like interiors and the luxurious
outer appearance of the place begged for an explanation, but he didn't
volunteer any, nor did I ask him for one.

Because for me there was only one question that had mattered since I
stepped into the bizarre facility: If what Martinez had said about no
one ever having run away was true, then what really happened to David
Pearson in this place?

The next few hours gave me little time to think. On Martinez's
instructions I left my bag in my room, first retrieving from it all my
identification papers and past medical records.

"We lock our patients' important documents in the safe," he
informed me as he flipped through them.

"Where's your passport?" he added, suddenly frowning.

I'd used it to cross the border as Earl Garnet, knowing that the
customs official would probably run it through a scanner and thereby
create a record of my entering Mexico--a key component of Janet's
contingency plans. Another precaution was to lock that passport along
with all other paper traces of me in the trunk of my rented car, which
I'd left parked at the Tijuana bus terminal--in case she needed access
to more proof that I was still in the country.

"I'm afraid I've let my passport lapse," I replied sheepishly, "as I
have just about everything else in my life. Luckily my birth
certificate was acceptable to the customs officer."

He found the laminated card among the sheaf of papers, then commented,
"Crossing our border without photo ID is unusual. Dr. Kane. After
all, a lot of people have blue eyes."

I grinned at him.

"As I said, I was lucky" He studied me for a few seconds, and I felt my
skin prickle with sweat. Then he shrugged.

"Come, let me take you to get some food."

Exhaling with relief, I slipped into another of my planned responses,
again modeled after the behavior of patients I'd seen who had quit
drinking only a few days before.

"Actually, I'm not that hungry," I protested, and given the cabbage
aroma I'd been inhaling all along the corridors, it wasn't a lie.

"But I could sure use some coffee."

"Of course," Martinez said, nodding knowingly.

"We can have some together in my office."

We set off along a different corridor--"A shortcut," he explained--the
white walls and checkered linoleum still the dominant motif. On the
way I caught sight of what seemed like a small resuscitation facility.
Inside were a monitor defibrillator unit and an anesthetic cart
alongside a stretcher, and on the walls were oxygen outlets. I'd no
sooner stuck my head in to get a better look than Martinez hustled me
out again, as opposed to showing it off, the way he had everything
else.

"We better hurry," he urged, "because our lab tech is staying late this
evening specifically to draw your bloods and process them."

I politely acquiesced, but not before I'd spotted a glass cabinet full
of familiar-looking vials I recognized as a variety of anesthetic
agents. Feeling the hairs stir at the back of my neck, I chose my
words carefully.

"My, you certainly seem prepared for every medical eventuality,
including cardiac arrest.

I'm very impressed. Do you also do minor OR procedures under general
here, or is awake sedation for sc opic examinations the limit?" Get
him boasting again, I thought, this time about how they might use an
anesthetist, and he may let slip why they'd brought in Hector
Saswald.

Martinez still wasn't biting.

"What we do with our patients, as I told you before, Dr. Kane, you'll
learn in good time."

Over coffee, and under the guise of chitchat he put me to the test
about Arthur Kane's background, deftly exploring and probing the man's
personal history as any psychiatrist would. Thanks to all my practice
sessions with Janet, I made no errors. Then he casually quizzed me
about my hospital and working in New York. My previous knowledge of
the city got me through that. Finally he ordered me to prepare for my
promised physical. Minutes later I was in his adjacent room lying on
an examining table--stripped, cold, and at my most vulnerable so far.

"You have none of the usual stigmata of excessive
drinking-telangiectasia, spider nevi, a medusa's cap--not one. Dr.

Kane," Martinez commented as he inspected my skin for the telltale
vascular markings.

"Yeah, I've been lucky that way," I said with a nervous laugh. It was
unusual but not impossible for a heavy drinker to be without them. I
kept studying Martinez's face for any indication that he was growing
suspicious.

"But what are these fresh scars from?"
"A fight with another drunk who had a straight razor, during my last
bender."

He raised his eyebrows at that, then returned his expression to neutral
as he moved on to poke and prod the rest of me.

"You also seem to have gotten to us in time before you did yourself
much hepatic damage," he said dryly while palpating and tapping out
with his fingers the shape of my normal-sized liver.

"Thank God!" I exclaimed, as if grateful for the miracle By the expert
way he was going over me, I could tell that unlike a lot of
psychiatrists, he hadn't lost his ability to do a thorough assessment
of a patient's physical state of health.

"Just my luck," I muttered, pulling my clothes back on when he'd
finished. I followed him back into his office and sat opposite him at
his desk. He remained hunched over my fabricated record, frowning
while riming through its contents. From the color of the papers he was
concentrating on, I could tell he was paying particular attention to
the biochemical profile of my liver function. I'd concocted results
that returned to normal after each hinge, and documented my latest
drinking episode as having been nipped in the bud, before even
transient damage had been done, but it might not fool him.

My pulse kicked up a notch as I quickly searched his expression again
for any signs that he was on to me. But I could read only puzzlement
in the piercing dark eyes that roved beneath his furrowed brow as he
continued to pore over the bogus reports.

"Very lucky indeed. Doctor," he finally said, sliding into his smiling
self once more. He then called for his long waiting technician,
ordered her to draw blood samples, including a specimen to be tested
for an alcohol level, and presented me with a medical release form to
sign.

"You know the formality, Doctor. It basically states that you agree to
participate as a subject in our experimental program."

Besides specifying the staggering financial penalties that would be
levied against me if I broke silence about the secret study, the form
was so blatantly in violation of any U.S.

informed-consent norms that no physician, not even a drunk like Arthur
Kane, would agree to the terms without at least some protest.

"It doesn't indicate what I'm letting you do to me," I objected after
reading it through, improvising what I thought would be my character's
response.

Martinez's eyes widened in a show of surprise.

"Dr. Kane, it's you who came to us--begged me in fact to let you into
the program. I already warned you over the phone that we had stringent
conditions in force to guard against plagiarism. You told me that
didn't matter, as long as we helped you. But if you've changed your
mind," he said, glancing at his watch and suddenly flashing me his
happy face again, "a bus going to Tijuana passes our road within the
hour, and I'll drive you to meet it. Of course, I'm afraid I cannot
refund your fee, as we already have gone to considerable expense in
making special arrangements to include you in our study."

I was getting sick of that easy smile of his, especially the way it
seemed brightest whenever we discussed money.

After whining a few more times about the unfairness of it all, I made a
show of begrudgingly agreeing to stay, leaned forward, and sullenly
penned "Arthur Kane" on the appropriate line. Janet had had the
foresight to make sure I'd practiced the man's signature until I could
replicate how it appeared on his various cards and documents.

"Fine, Dr. Kane, fine," Martinez enthused, slipping the paper into the
rest of my file without so much as a glance at it.

He then tilted back in his chair and eyed me for a few seconds.

As far as I could tell, I'd fooled him every step of the way.

But given his reluctance all evening to divulge anything, I was
expecting to be dismissed, no wiser about David and resigned to staying
that way at least until morning.

Instead he announced, "Now, how about a demonstration of what we have
in store for you?"
Chapter 19

"You've heard of the works of Pavlov, haven't you. Dr.

Kane?" Martinez asked, leading the way through the dimly lit corridor,
his white coat flowing out behind him.

The unexpected question startled me.

"Of course."

"And you recall how Pavlov's famous experiment--making dogs salivate at
the sound of the dinner bell instead of at the sight of food--was the
first demonstration that physiological reflexes in animals could be
conditioned to respond to a secondary stimulus?"

I wanted to tell him to quit patronizing me, but held my tongue and
simply nodded while hurrying to keep abreast of him. He hadn't said
where we were going, but we seemed to be heading back through his
shortcut. The sameness of the passageways made it hard to tell.

"And I presume your medical school training gave you at least an
introduction to the works of Skinner?"

Skinner had been the father of modern behavioral science and had
developed during the fifties and sixties the theory of conditioning
behavior through associative rewards, again using laboratory animals,
mostly rats running a maze for food. He was required reading for even
premed students.

"That's right," I answered, remembering back to those early courses.

"And are you also familiar with his work done during the sixties on the
next step: negative reinforcement?" Martinez continued.
"Yes," I snapped, irritated now by his not getting to the 282 point.

"Skinner's rats could be made not to do a specific type of fundamental
behavior, such as eating, by associating that activity with the
repeated application of electric shocks," I elaborated, hoping to
demonstrate he needn't review the basics.

I may not have thought much about basic psychology since medical
school--a doctor's mind files away colossal amounts of information that
is learned early in training yet never needed in practice--but I did
remember it.

He led us past the resuscitation room--the door was closed and I could
hear the murmur of voices inside. Instead we entered a small adjacent
cubicle that was bare of furniture but had a set of dark green curtains
drawn across one wall.

"Do you also recall the controversy the work of that period caused?" he
asked, nicking on the light and shutting the door behind us.

Now I was getting interested.

"Mind control," the critics had called it.

"A powerful tool to modify aberrant behavior," advocates had trumpeted.
A famous British film director had even made a popular movie in which
he prophesied its use in the treatment of sociopaths. But ultimately
all the hoopla had died when the technique proved far less effective in
permanently modifying people's actions than anyone had first hoped, or
feared.

"Sure," I replied.

"It was very topical, and a whole flourish of scientific debate
appeared in the various medical journals of the time--all about the
ethics of using such techniques with humans."

"And are you aware of the first human trials which applied the
principles of negative reinforcement to inhibit drinking in
alcoholics?"

I caught my breath. His question had made me remember a solitary
seminar on a sleepy, autumnal afternoon from over thirty years ago.

"Oh, my God!" I involuntarily exclaimed, all at once recalling what it
was that a psychiatrist, an anesthetist, an alcoholic, and an addiction
center had in common.
A team of psychologists from Canada and England had been visiting
major U.S. medical schools. They were attempting to enlist
participation in a multi centered trial aimed at using an extreme form
of aversion therapy to stop alcoholics from drinking.

"There is no greater drive in the human body than to breathe," their
key spokesman had claimed.

"Choke that function off with paralytic agents, in association with the
subject taking a drink of his or her favorite beverage, do it often
enough, and soon the very sight, smell, and taste of the drink itself
will become the secondary stimulus that will produce in our subject the
same extreme terror associated with suffocation. In short, fear and
pain will overcome the craving, and the subject will be unable to
imbibe."

Despite his optimistic hypothesis, no American centers had agreed to
participate in the study. Later we learned that the Canadians hadn't
produced any better results with the technique than those achieved by
the methods of Alcoholics Anonymous. And though the group in England
managed to reduce a community's use of their local pub by seventy
percent, few of those participating drinkers, on closer analysis, had
really been alcoholics. The investigators abandoned their trials
shortly afterward, one of our professors subsequently told us the
following year. To me, it meant one less thing I had to remember.

Martinez had come to a standstill in front of the green curtains, his
arms folded, his brow arching toward his jet-black hairline.

"I take it from your reaction that you have heard something about that
early work. I'm surprised. It was pretty esoteric stuff," he
commented.

If you have to improvise a story, Janet advised me before I left, make
it your own.

I related an account of the seminar, casting Arthur Kane, aspiring
urologist, as the overworked, overtired student who'd vaguely paid
attention.

When I finished, Martinez leaned back into the green folds behind him
and against what I presumed was a one-way mirror. He casually crossed
one leg over the other, flashed me a grin, and asked, "Do you know why
those trials yielded such poor results. Doctor?"

My God, that smile of his was insufferable, I thought while dutifully
admitting, "I haven't any idea."

"Think about what we've learned from PTS disorders.

That's where I found the answer."

"What?" I wasn't sure I'd heard him correctly. The initials PTS stood
for post-traumatic stress, a condition we were seeing all too
frequently in military personnel, thanks to places like Iraq, Somalia,
and the Balkans.

"But what's that got to do with alcoholism?" I had no idea where he
was going with this.

Martinez took a breath, puffing himself up like an opera singer about
to deliver an aria.

"As in all therapies, dosage was the key--the amounts given, the
interval between successive administrations, and the total duration of
the treatment," he pronounced.

"In the British and Canadian study, those parameters were woefully
inadequate, and the ethics of that time would not tolerate those
researchers making the necessary adjustments. Now, however, it's a
different matter.

"Effective, efficient, and cheap," is the new ethos of the health care
industry, and that reopens the door to therapeutic modalities
previously regarded as completely unacceptable." He was talking so
fast that he had to pause for a gulp of air.

"That's where my understanding of post-traumatic stress disorders came
into the picture."

Martinez uncoiled himself and began to pace in front of the curtain,
his eyes eager.

"I became experienced with the syndrome when I was working for the
penal service. It used to strike me how prisoners, after a series of
vigorous interrogations, actually relived the sessions, over and over,
as opposed to simply remembering them. It was as if their recall of
the trauma had bypassed the part of the brain that normally
distinguishes between an event that is being remembered and one that is
actually being experienced..."

Shit! I thought. He's talking about torture.
"... I also noticed that these flashbacks could be triggered by a
sound, a smell, or a sight associated with the original interrogations,
much the way a secondary stimulus had tricked Pavlov's dogs into
salivating," he continued, his eyes afire.

"You can see the logical progression. Negative inhibition taken to its
extremes could be considered nothing more than the induction of a very
specific post-traumatic stress disorder--in this case, a flashback of
prolonged suffocation triggered by the sight, smell, or taste of
alcohol."

Disgust was all I could feel. It grew like a slowly cresting wave and
caught in the back of my throat. Still, I had to learn more.
Swallowing bile and managing to feign respect, I asked, "So how have
you altered the original protocol used in the sixties?"

In answer, he strode over to a dimmer switch, lowered the lights, then,
with a flourish befitting an artist unveiling his masterpiece, threw
open the curtains.

The harsh light in the white resuscitation room made it easy to see. A
gaunt, middle-aged man with a terrified look on his face was sitting on
the stretcher wearing nothing but a Johnny shirt. His skinny legs
dangled nearly to the floor, and his thin arms protruded from the
white, half-length sleeves, appearing not much more substantial-looking
than those of a frail puppet. And though there were no speakers turned
on to let me hear, he seemed to be pleading with a nurse who was
starting an IV on him.

From behind me Martinez said, "I've upped the duration of induced apnea
by fifty percent to eighty seconds, reduced the interval between
reinforcement sessions to a matter of hours, and extended the whole
process to be repeated for five days straight." His matter-of-fact
tone sounded as trouble-free as if he'd been describing how he'd souped
up his car.

"This man, along with those whom you saw in the dining hall, will be
finishing their final sessions tomorrow morning, after you start yours.
They'll be heading home by noon."

My insides turned to ice.

"I start in the morning?"
Those thin limbs began to flail and kick. A second nurse and an
orderly moved in to restrain the man, grabbing his arms while the first
nurse slipped an IV needle into a bulging vein below his elbow.

"Of course. That way you'll be returning home yourself, to New York
and a new life, by Sunday. Did I mention our success rate that you're
going to benefit from? Eighty percent of our subjects are still dry
since the program began two years ago. And thanks to Brama's
recruiting efforts, we've been processing six patients a week--that's
six hundred subjects so far. I figure we'll need a thousand in our
sample before our statistics will be bulletproof enough to override the
moral outrage that's bound to arise in your country..."

By that point I'd tuned out. I only had eyes for the struggling figure
on the other side of the mirror. All I could think of doing was to say
I'd changed my mind and then get the hell out of there.

"... you know yourself that well over a hundred billion-some experts
say it's more--is spent each year in your country treating
alcohol-related illnesses--GI bleeds, liver failure, trauma--and what
we're offering has the potential to reduce that amount by eighty
percent. Imagine an eighty billion dollar savings in health care
expenditures, and the subsequent boost to HMO profits..."

A man wearing a surgical mask had stepped up to the head of the table
and was checking a tray full of intubation equipment, indifferent to
the struggle going on beside him. Martinez continued to spurt
statistics into my ear.

"... Brama, of course, was the first to grasp the promise of these
benefits when they provided our start-up capital. But once the rest of
the health care industry latches on to the scope of those savings,
especially when they see how effective, quick, and economical our
methods are compared to current treatments--for instance, we've got the
anti craving drugs beat hands down.. ."

His voice sounded so breathless that I glanced back at him.
He'd become flushed, and as he enthusiastically continued to expound
his vision to turn the treatment of addiction on its ear, his eyes
remained riveted on what was happening beyond the one-way mirror, a
miniature of the ordeal reflected on their glazed surface.

"... there'll be no stopping the demand for access to our program from
any number of HMOs. We'll of course offer it through facilities like
this one--more outlets on our side of the border are in the
plans--since Mexican regulations are far more progressive regarding
clinics offering innovative therapies..."

I was both repelled and fascinated by the spectacle of him.

He was so aglow with what seemed like genuine pride, so swept away by
the prospect of his success, yet so steeped in the trappings of
science, that I found myself wondering if he could even fathom the
monstrousness of what he'd become-a torturer in a white coat. I looked
back through the mirror in time to see the man on the table lash out
with one of his spindly legs and deliver a feeble kick at his
tormentors, the whites of his eyes bulging as he strained his head away
and the orderly forced a glass of amber-colored liquid to his lips.

"... we feel coercion is justified rather than let a patient face a
return to drinking and a twenty percent risk of sudden death. All
those subjects who initially rebel against the procedure are therefore
restrained and forcibly subjected to the ordeal..."

So much for my refusing treatment, I told myself, breaking into a cold
sweat and feeling my pulse rocket. But as I watched, I realized the
worst of what Martinez had been saying. There'd be many in the
business of medicine--doctors included--who'd find his arguments
compelling. In fact, it suddenly dawned on me that as long as patients
were desperate enough to sign that wretched release form and they
agreed to the treatments on Mexican soil, everything that he'd
described was not only doable, it was probably legal.
"... our use of American anesthetists can only add to the credibility
of the study. And there are other applications of behavior
modification to consider--we could condition drug addicts against
needles ..."

The anesthetist picked up a large syringe filled with clear fluid,
reached over the writhing man, and unceremoniously injected the
contents into his IV line. The people restraining him stood back. The
man looked disbelievingly at them, his eyes wide, his mouth open in
dismay as if he still couldn't quite believe what they'd done to him.
He suddenly began taking great breaths of air, his chest heaving,
until, seconds later, the muscles in his arms and legs started to
quiver and he fell back on the table, his body crumpling as lifelessly
as if he'd been shot through the brain. His mouth hung slack; his eyes
stared straight ahead; his limbs swung loosely above the floor.

I forced myself to stand there, watch, and not give myself away. Yet
every instinct I had was shrieking at me to move in and resuscitate the
man. I was also desperately trying to figure how I could get myself
out of there. But if no one else had ever escaped, how the hell was I
going to?

"... of course, against a disease with that kind of mortality, our own
one percent rate associated with the procedure itself falls within the
norms of acceptable risk compared with other lifesaving operations. We
certainly rival the mortality numbers associated with carotid
endarterectomies for embolic stroke victims, or cardiac transplant
procedures for patients with end stage heart failure. By the time
people in your country realize this risk, they'll be reaping such
fantastic benefits from the procedure that the chance of an occasional
mortality will seem more than acceptable--" "Wait a minute," I
interrupted, turning to face him when his words finally registered.

"A mortality of one percent?" I'd been so horrified by what I was
seeing that at first I missed the significance of what he'd said.
"Yes," he replied enthusiastically.

"Isn't it wonderful? Compared to the twenty percent chance of a sudden
alcohol-related death, that's a ninety-five percent relative risk
reduction--" "Dr. Martinez," a curt voice interrupted from the doorway
behind us. I swung around to see a stocky, middle-aged man who'd
entered without knocking. In the partial light coming through the
mirror, I could make out his swarthy complexion and that he was every
bit as well-dressed as the psychiatrist.

When he stepped closer, I noticed a key chain bearing the Mercedes logo
dangling from his right hand, leading me to presume that I was looking
at the owner of the green car in the CEO's spot. I had no idea how
much of our conversation he'd heard, but by the dour look on his face,
I could tell he wasn't happy.

He let loose a furious stream of Spanish at Martinez, which I hadn't a
hope of following, then turned to me.

"Dr. Kane, I am Mr. Vasquez, chief executive officer of this
facility." His English wasn't nearly as good as Martinez's, but it was
a hell of a lot better than my Spanish.

"You should return to your quarters and get some sleep," he continued,
then gestured toward the mirror.

"As you have seen, tomorrow you face a harrowing ordeal."

I glanced once more at the man on the table. Holding an airway and a
ventilating mask, ready to resuscitate, the anesthetist stood over him.
I shuddered, unable to imagine the agony he was enduring behind those
dead-looking eyes.

"Now if you'll excuse us, Dr. Martinez and I need a word in private,"
Vasquez concluded, abruptly inviting me to leave by gesturing toward
the doorway with his outstretched left hand.

Martinez gave me an embarrassed shrug.

"Mr. Vasquez is correct. You need your rest."

Just like at home, I thought. CEOs outrank doctors.

"You'll find an open kitchen in the dining hall where you can prepare
coffee, tea, and light snacks," the psychiatrist added, "but I remind
you that since we start tomorrow morning, you should have nothing to
eat or drink past midnight."
It was the standard warning given patients who were facing an
anesthetic procedure, intended to guarantee an empty stomach and
thereby prevent the aspiration of vomit.

I'd pronounced it myself a thousand times to patients headed to the OR.
To hear the familiar caution given in preparation for my being
tortured' seemed surreal.

Over Martinez's shoulder I stole a final glimpse at what was happening
in the next room. The anesthetist had finally started to help his
victim breathe.

Trying not to show how rattled I felt, I said good night. But as I
passed in front of Vasquez I caught sight of at least one thing that
made him different from CEOs at home, and accounted for the slight
bulge I'd noticed beneath his blazer.

Under his outstretched arm I could see that he was carrying a gun.

Before the door had even closed behind me, Vasquez resumed his argument
with the psychiatrist, in Spanish. A few words caught my ears--
"Baines.. . telefono... paci ente privado... seprohibe"--enough to
make me slow my walk and linger in the hallway. For a few seconds I
could only hear the murmur of their voices, then Vasquez began
shouting, "Cinco mil," and Martinez screamed back, "dos mil." After
they yelled the phrases at each other a few times, Vasquez unleashed
another blistering torrent of undecipherable Spanish, this time from
just inside the door. Fearing he was about to come out at any moment,
I scooted down the corridor and out of sight around a corner, praying
that the CEO's threat to phone Baines about the "prohibited private
patient" was simply part of his extorting a bigger share of Martinez's
secret take.

I listened as the two men came into the hallway, still arguing.

Then Vasquez hissed, "Silencio! " and I heard a single set of steps
walking away toward the front entrance. I carefully took a peek, and
saw a scowling Martinez just as he entered the resuscitation room and
closed the door behind him.

The sound of Vasquez's steps going the other way continued.
I listened until I heard them stop, and the hollow sound of distant
men's voices came drifting back down the darkened passage as if from
some faraway swimming pool.

He was speaking to the guards. Then I heard a harsh buzzing noise, and
seconds later the sound of that big metal door shutting after him rang
through the halls like a gunshot.

I initially retreated to my room to try and digest what I'd seen and
heard. Minutes later I fled back into the corridors, feeling too
claustrophobic to think straight and needing to pace. Soon I found my
way into one of the unused sections still under construction, but even
as I strode here and there, pursued by my thoughts and trying to find
an exit, my wandering those passages with their white walls and
checkered floors felt like I was running a maze on a chessboard.

David Pearson was surely dead. So were five other patients who'd come
here. Martinez had as much as confessed that he'd killed them when he
let slip the real secret of this place-a one percent mortality rate
among six hundred subjects.

That's what Baines, and before him Saswald and Forbes, had been so
determined to keep hidden. Those deaths, covering them up, and
continuing to recruit unsuspecting patients into a one-in-a-hundred
chance of dying meant they'd conspired to commit and get away with
murder. But these weren't clever no-fault murders. Neither their
having set up shop amid a haven of lax regulations in Mexico nor their
unscrupulously worded disclaimers and release forms could protect them
now. They were guilty of killing people, pure and simple. And I could
nail them for it.

I could also be killed for my efforts. I doubted that men facing six
murder charges would hesitate about a seventh to save their skins.

As I continued scurrying this way and that through the semidark
passageways like one of Skinner's rats, I kept watch for a quick exit,
but to no avail. Despite the incomplete construction, not only were
the windows and doors locked, they were all wired to an alarm system.
And even if I broke the glass in one of them and crawled through, I
could see enough security cameras on the floodlit grounds to realize
that the guards would spot me immediately.

I slowed my pace, tried to steady my nerve, and reined in my impulse to
make a break for it. Besides, a glance at my watch told me the bus to
Tijuana that Martinez had mentioned had long since passed by on the
highway below.

I reached the end of the building and pulled up before yet another set
of locked windows. Before long the panes in front of me were so awash
with rain that the scene beyond dissolved into vertical streams of
light and dark. As I stood there I kept telling myself that I'd found
exactly what I needed to put an end to Baines, to Brama, and even to
Jack's mad scheme. I just had to continue in my role as Arthur Kane
and survive the next forty-eight hours. That's when Janet's ultimate
contingency plan would kick in if she hadn't heard from me, I thought
reassuringly, and she'd be notifying Riley that I was in trouble.

Outside, the wind moaned, lightning ripped the black sky to shreds, and
a growl of thunder made itself felt as well as heard, its impact on the
surrounding rocky terrain vibrating up through the floor. La Rumorosa
was living up to its name tonight.

I tried finding the route back to my room, but the uniformity of it
all--the whiteness of the place, the dull light, the checkered
floors--continued to confound my sense of direction.

I kept having to backtrack after going up a series of culde-sacs lined
with cubicles no bigger than my own, but none of them were mine. The
accidental tour at least served to show the scale on which Martinez and
Baines planned to "treat" victims once they were fully operational. But
how could they cover up a one percent mortality rate on such large
numbers? They couldn't simply claim they'd all run away.
Then I thought about what Martinez had been saying just before Vasquez
interrupted. How had he put it? By the time people in your country
realize the risk, the benefits will far outweigh an occasional
mortality.... "Of course," I murmured, breaking the creepy stillness
all around me between the rolling rumbles of the storm. They wouldn't
have to conceal it. They'd probably counted on covering up only the
initial deaths in order to publish their treatment as being absolutely
safe as well as effective, to help ensure its acceptance. But once the
treatment came into demand and was more widely used, they could simply
claim that the problems being encountered hadn't arisen during their
research. And since all new treatments have more side effects once
they're in general use than during clinical trials, Martinez and Baines
would most likely get away with the lie.

Certainly Martinez was right that not just Brama, but the entire HMO
industry had an incentive to accept the program.

And he was also right that once those other companies got a taste of
that eighty percent savings, extreme aversion therapy would have a hell
of a good chance of becoming their treatment of choice for alcoholism,
despite the consequent controversy and a one percent mortality rate.

I rounded yet another corner and ran into a severe-looking security
guard making his rounds.

"Que hace us ted aqui? " he demanded sternly.

"I can't find my bedroom," I replied, having no idea what he'd asked.

"Ah!" he said, smiling, and beckoned me to follow. He led me to the
dining hall.

"Gracias," I told him anyway, figuring I could use at least a cup of
tea and some toast. I still wasn't hungry, but from the burning I
could feel in my stomach, I figured it was churning empty on pure acid.
And I'd far rather get my thoughts together here, I thought, than in
that oppressive little chamber I'd left over an hour ago.
There were only three men sitting at the benches, each one by himself,
and not one of them appeared likely to bother me.

They all had the same hollow-eyed stare that I'd seen in war photos
ofGIs after they'd been in battle. I shuddered when it struck me that
by tomorrow I'd look like that.

I walked over to a table where an urn of coffee and another of hot
water stood ready. A toaster was beside them, a loaf of homemade
bread, butter, and pots of jam arranged in front of it. On a nearby
shelf I found a canister of tea bags and prepared myself a cup. The
simple routine was soothing.

I then found the sugar in dispensers on the tables, but couldn't locate
either creamers or pitchers of the real thing.

"Excuse me," I said to one of the silent men at a nearby bench, "could
you please tell me where the milk is?"

He slowly turned to look at me. His cheeks and nose were crisscrossed
with enough webs of red and blue veins to make him appear sixty, but he
still had the lean frame of a young man.

"Try the fridge," he growled, pointing into the kitchen, then returned
his attention to the bottom of his cup.

I retrieved what I wanted, made some toast, and took a seat off in a
corner. I'd just taken my first sip of the warm sweet drink and was
waiting for it to work its usual magic on my stomach when the gruff man
I'd spoken to suddenly let out a huge sob. The sound of it echoed
through the silence of that big hall with the volume of a shout.
Startled, my cup still suspended halfway to my mouth, I watched his
whole body begin to shake, then listened to him give a succession of
hoarse cries as if he were in a paroxysm of coughing. Within seconds
he settled into a steady wailing, which he muffled somewhat by burying
his head in his arms.

I looked around, expecting at least one of the other two men in the
room to react and come to his aid, since they probably knew him. But
it was as if they didn't even hear his cries. Their inaction left me
unsure myself of what to do-comfort him or leave him alone. As I
watched, still uncertain, he raised his head, wrapped his arms around
his chest, and began to rock, muttering something as tears rolled down
his ravaged face. At first I thought he was praying, perhaps saying
his rosary, but then the words became louder and I could make them out.
Over and over, like a curse, he kept uttering, "It feels like death ...
It feels like death ... It feels like death..."
Chapter 20

Five steps and turn; five steps more and turn again--I was doing the
jailhouse shuffle back in my room. The place was growing colder by the
hour, the night taking back whatever heat the previous day had
provided. Neither did it help that here on the third floor all six
sides of my little stone cubicle reverberated with the percussion of
the mounting tempest.

"Just like my skull," I shouted into one of the booming crescendos.

To make matters worse, the cups of tea and innumerable slices of toast
I'd downed, instead of having soothed my stomach, remained a lump
amidst its tightening coils.

I'd gone to the sobbing man in the dining hall and managed to get him
calmed down. The other two patients then drifted over to join us, and
all three men eventually proceeded to describe in detail their own
experience of what I'd seen earlier.

Talking about the ordeal seemed to help them--treatment for PTS
involves discussing the underlying trauma--so I'd listened quietly. Now
in the darkness--the lights had gone off at midnight, the moment the
automatic lock clicked shut in my door--I couldn't stop dwelling on
their descriptions of asphyxia, and felt all the more confined for it.
Images loomed out of the dark--apparitions of David stretched out on a
table, paralyzed, staring, and turning blue as he died. These
instantly transformed, and it was me I saw lying there.

"Only one-in-a-hundred chance," I uttered over and over like an
incantation, trying to dispel the troubling prophecy. My mind quickly
obliged by changing to a less personal but no less 297 horrific venue,
conjuring scenes of a raging Alien as he dispatched Saswald and Forbes
with a stroke of his knife. Yet in the middle of this whirling
tumultuous free-for-all of visions, a very simple question posed
itself. How had Alien found out what they'd done to his father?

I forced myself to stop pacing and sat on the side of the bed, fumbling
in my bag for a portable radio I'd brought.

Using the earpiece, I found an oldies station out of San Diego, and
blasted it into my brain, hoping to force it into neutral. But even up
against the sounds of Wilson Pickett belting out "Ride, Sally, Ride,"
my thinking wouldn't stop.

I kept dwelling on the fact that there was no way to explain how the
young Marine could have penetrated the secrecy of this place, no matter
how I tried, without evoking improbable scenarios involving someone
from the clinic passing him information.

Yet it seemed equally improbable to consider that he hadn't killed
Saswald and Forbes. The idea of Pearson too young being a killer's
diversion intended not only to incriminate David, but encrypted to
ultimately cast suspicion on Alien as well, was the most farfetched
possibility of all.

"Shit! Shit! Shit!" I yelled above the music and thunder, but my
mind still refused to quit. What if Janet was absolutely right about
Jack MacGregor? it screamed back. What if he had become an assassin,
and everything else he said was a lie?

I cranked up the volume on my radio as far as it would go.

Otis Redding filled my head with the strains of "Try a Little
Tenderness."

"... the bombing occurred at two a.m." causing extensive damage to the
company's head office in San Francisco.

Brama has had a turbulent history with patients' rights groups, and
most recently has been in the news because of controversy over their
aggressive triage policies regarding approval of payment for ER visits.
Critics say their practice
of withholding fall authorization often intimidates patients and leads
to fatal delays in their receiving care..."

I woke up to complete darkness, wondering who the hell was screaming in
my ear. Then I felt the plug and wire from the radio.

"... all the other attacks seem to involve well-coordinated home
invasions at the residences of various CEOs from the company. These
occurred simultaneously in at least twenty states, timed to coincide
with the bombing, leaving no doubt that it is a well-organized
terrorist operation the scope of which this country has never seen.
There are still reports of similar home invasions coming in from other
cities..."

In a flash I was awake and sitting bolt upright.

"... in all cases the houses have been occupied by members of a group
calling themselves the PDL, which we've been told stands for the
Patient Defense League. Details remain sketchy, but it appears that in
the cases we know of, the families of each CEO have been let go while
the company officers themselves are being detained as hostages. No
direct threats have been made against these captives, but there is an
ominous pattern developing. In every incident, the hostage takers have
issued a typewritten statement in which they declared their readiness
to die and then the details of how the insurance company, they claim,
has killed a loved one. We are getting copies of these as I'm talking
to you, and from those I've glanced at, if half their charges are true,
it seems that Brama is facing a very determined and angry group of
Americans..."

For the rest of the night I lay awake listening to the bulletins and
half-hour reports as they came in.

"...a warning was given prior to the explosion, giving authorities time
to evacuate the building before anyone might be hurt. Police suspect
that a car bomb was left overnight in the underground parking garage by
an employee..."
"... the terrorists resorting to attacks on the homes of CEOs may have
been the result of increased security at their offices due to recent
threats against Brama..."

"... a detailed list of demands has been e-mailed to major media
outlets, basically stating that unless Brama abandons its current
triage policies and makes financial restitution to the survivors of
those who have died, more attacks on facilities and responsible
personnel will follow..."

The broadcasts were all the more compelling as the identity of the
captors became known and the people who knew them--friends, relatives,
neighbors--began giving interviews.

"... he's been devastated since his wife died. Suicidal, even..."

"... his son's death seemed to finish him..."

"... they're a religious, law-abiding couple, but when they lost their
daughter..."

Then William Baines gave a statement as he was intercepted by a
reporter at the airport in Buffalo.

"... the leader of these fanatics is a longtime troublemaker named Dr.
Jack MacGregor. He's already wanted by the police for the theft of
medical documents from our San Francisco office, and last week I
understand he added kidnapping to his list of crimes when he drugged
and briefly detained a former colleague of his in Buffalo. Clearly
he's a disturbed individual--" "But Mr. Baines, the people who took
your chief executive officers hostage have reputations as reasonable
men and women. And their claims of what your company did to their
family members are a pretty damning indictment--" "It's reporters like
you who give encouragement to crazies like Jack MacGregor," Baines
barked.

"Let me tell you the facts. First of all, we never withheld care from
anyone. It's the doctors who are responsible for deciding what
treatments are or are not necessary for any given patient. Second,
wherever Brama sets up shop, we not only provide medical services to
millions of Americans, we also ensure it stays in business, able to
continue meeting that obligation, by discouraging frivolous visits to
hospitals. That vigilance results in a one percent savings, and as
little as this sounds, it's the difference between going belly up and
defaulting on our responsibilities to all our clients, or remaining
solvent, fully capable of serving people who have real problems. And
what's wrong with that? You wouldn't want a health care provider that
looks after its finances so poorly that you can't be sure it'll have
the money for the care you need when your time comes to be sick or
injured. As a CEO, it seems to me that I'd not be performing my civic
duty if I allowed that to happen."

"So what's your point?"

"My point is that Jack MacGregor is manipulating people who are
genuinely ravaged by grief. And to those misguided individuals who
have been swayed by this madman, I say stop now, before someone gets
hurt or dies."

"But what about their charges against Brama? Their demands for
compensation?"

"Brama always acts within the law. If anyone has legal arguments
against us, let them make it in court, not through vigilante action.
Now if you'll excuse me, I'm heading to San Francisco and have a plane
to catch."

"But they have been to court--" "I have no further comment!"

"Isn't it because you're unaccountable for these deaths in a court of
law that you've been accused of committing no-fault murder--" "That's a
crock!" he snapped, abandoning his controlled, public-relations voice
for tones of raw anger.

"And I'll see you in court, along with anyone else who repeats that
charge!"

"In court?" the interviewer said incredulously, completely losing her
own neutrality.

"I'm simply quoting other--" "In court, you understand, damn you! That
insidious phrase has been used by the media to systematically libel me,
my company, and the HMO industry at large. I personally won't have it
anymore."
"How is the phrase 'no-fault murder' libelous to you personally--"
"You're a disgrace to objective journalism!" he shrieked.

"Go away! I have nothing else to say."

As the interview was cut off, I ripped out my earplug.

"You'll have a lot more to say, you self-serving son of a bitch, if
I've got anything to do with it!" I yelled aloud, elated that he'd
just made such a fool of himself. As my words cannonaded around the
absolute darkness of the room, my mood quickly grew somber.

If even one of Jack's group lost control and a hostage died as a
result, they'd all be charged with murder. Worse still, a single death
like that, if it provoked the police to move in on all the other
hostage-takers, could spark the mass suicide I'd so feared.

I got up and started pacing again. Maybe I could still limit the
damage. Get Baines arrested for the murder of David Pearson before a
disaster happened, even accuse him of complicity in the deaths of the
five other patients whom I assumed had disappeared. The president of
Brama being led off in handcuffs on national media might still be
enough to convince at least some of the hostage-takers that they could
back down and let justice take its course. But I had to get out of
here now!

Absently I noticed that the closed space was no longer filled with the
feel and sound of rumbling. The storm must have stopped.

As for Jack, I thought, there'd be no helping him after this.

Even if by some miracle not a single life was lost and his people
ultimately called off their campaign, he faced a life in prison for
what he'd instigated. I strode back and forth in that black, cold
dampness, surrounded by a quiet befitting a crypt, and knew he'd kill
himself before he'd submit to rotting in a cell.
At seven the overhead lights clicked on and the lock on my door
snapped open.

"Attention all patients," a voice in accented English announced over a
PA. speaker in the ceiling.

"You are reminded not to eat or drink before your treatment session.
Those of you who are leaving' at noon, have your belongings packed and
ready..."

I clicked on an idea. Perhaps I could slip a note to one of the men
whom I'd met last night and ask that he call Janet's cellular number
collect once he reached the phone booth at the highway--to say that her
husband needed help. It was a long shot, and even if he reported me,
it was the kind of plea that even a desperate and frightened Arthur
Kane might make. I didn't have to say Janet's last name, and the only
thing that might give me away would be the Buffalo area code instead of
the one for New York City. But I'd have to risk it.

After the sessions, I decided, in the dining hall, that's where I'd
make the attempt.

I shunned the public nakedness of the showers, feeling too vulnerable
as it was, and chose instead to wash with a wet cloth at the sink. I
also shaved and put on a clean shirt, in the tradition of the
condemned.

At 7:45 an orderly knocked at my door and indicated I was to follow
him. In the hallways a few nurses scurried by us.

"Buenos dias," they said politely to my companion while nodding
pleasantly to me. If they knew or cared about the events overtaking
their clinic's parent company north of the border, they didn't show
it.

Neither did Martinez.

"Good morning. Dr. Kane," he greeted me matter-of-factly at the door
to the resuscitation room.

"Now we change your life for the better, no?" He stepped inside and
ushered me with his outstretched arm to lie down on the stretcher.

A nurse with her back to me was at the counter in front of the
medication cabinet. I could see in the reflection of the glass that
she was breaking open a vial and drawing the contents into a large
syringe. She then turned and handed the filled needle to the masked
anesthetist I'd seen last night. As before, he was standing beside an
assortment of airways on a steel tray beside the head of the stretcher.
He said nothing, didn't even acknowledge me with his eyes as I lay down
and looked up at him. His gaze, cold as the wave of sweat that broke
out over my back, was fixed on the needle while he held it up in the
air and tapped the clear cylinder to remove air bubbles. He then
capped it and placed it on his tray, ready for use. I heard Martinez
begin explaining what they were about to do with me and felt the wet
coolness of rubbing alcohol as the nurse swabbed a vein in the front of
my left elbow. A stinging prick followed as she inserted the IV But I
kept my eye on the one who would inject me.

"... thirty seconds after the succinylcholine is given, you will feel
your muscles twitching, and then the paralysis will occur. The
transmission of neuro electrical impulses through the nerve ends to
striated muscle will be blocked, and all movement, including
respiration, will be stopped. It is the extreme unpleasantness of
mounting air-hunger that will, in the end, condition your response, and
so you will be allowed to endure it for eighty seconds. At that point,
the anesthetist will start to ventilate you and will carry on making
you breathe until the drug wears off, in about four minutes. Your
heart will continue to beat, and the drug won't affect your sphincters,
so you won't soil..."

It feels like death, was what I kept thinking as I ignored the droning
words and strained my eyes farther back to keep the anesthetist in
view. All I managed to see now were his hands as he deftly snapped the
blade of a laryngoscope open to make sure the light worked. Then he
glided his gloved fingers over an assortment of rubber tubes and black
curved airways arranged on his tray like an array of hors d'oeuvres. He
adjusted a few of these items so they'd be easier to reach. Close by,
also near enough to him that he could pull them into position when he
needed them, were portable oxygen tanks connected by green tubing to a
black bag and thick rubber mask.

"... you will pour a small amount of your usual drink into a glass.
First, smell it, then take a sip and hold the..."

The nurse moved up beside the anesthetist, bringing with her a small
steel table on wheels. It held a clear bottle the size of a large
pickle jar and a vacuum pump to provide suction.

She verified the motor was plugged into a wall outlet, then uncoiled a
beige-colored catheter with a metal tip and connected it to a tube
dangling from a stopper which sealed the bottle. The anesthetist
nicked a switch on the table and adjusted the force of suction until it
was adequate to clear vomit from an airway. A nod to the nurse, and
they were ready.

I felt myself start to sweat again as I sat up and watched the
psychiatrist reach down into a briefcase and pull out the small green
bottle I'd bought in Tijuana--flat, contoured to fit in a hip pocket,
and with a familiar yellow label. Some of his subjects even at this
point gulped the contents greedily, the three men had told me last
night. Others were too overwhelmed by fright to drink anything. If I
didn't play this part just right, someone might see through me, and I
could end up dead.

I saw the anesthetist pick up the syringe. The nurse dabbed a little
rubber side port on the IV line with an alcohol wipe, readying it for
the injection. At least my fear should pass muster, I tried to
reassure myself. It was absolutely genuine and mounting by the
second.

I took the bottle of whiskey from the psychiatrist when he held it out
to me, but my hands started to tremble and I fumbled with the cap. Once
I got it open, the nurse pressed a glass into my right hand, then
steadied it for me while I poured myself a mouthful of the amber
liquid. The familiar bouquet mingled with the medicinal smell given
off by her fingers. I felt the anesthetist move up to my left arm and
turned in time to see him jab the syringe into the rubber portal. His
thumb was poised on the plunger.
"Now take a sip," Martinez commanded, "then swirl it around in your
mouth."

I needn't have worried about giving a convincing performance.

My hands began to shake so badly that I was afraid I'd slosh the
contents over the sides of the glass. The nurse again steadied them
and helped me raise the drink to my lips. As the fluid entered my
mouth, I barely sensed the warmth on my tongue. Instead I kept
straining to see the syringe, watching the plunger. My whole body was
trembling now. It feels like death! I tried to swallow but gagged,
and the whiskey dribbled down my chin.

I couldn't continue. I had to stop this. I heard myself start to
moan.

"Swallow it!" the psychiatrist snapped, startling me with the sudden
harshness of his voice.

"Noooooo!" I wailed.

"I changed my mind!" I tried to twist my left arm away from the
anesthetist's grip.

But it was too late. He'd shoved in the plunger before I could pull
the IV away from the syringe.

I sat frozen, staring at my arm. The nurse quickly took the glass and
bottle out of my hands, but I was so transfixed on the IV site that I
barely noticed. The anesthetist moved to the head of the stretcher,
ready for what came next.

I felt a tingling sensation pass through my elbow and rise toward my
shoulder. I started to panic.

"No! No!" I pleaded, looking first at Martinez, then at the nurse.

"Stop it, please stop it!" But their returning gazes were cold. I
tried to yank the IV out, then clutched frantically at the upper part
of my left arm in a futile attempt to prevent the injection from
reaching the rest of my body. I was sobbing when the twitching
started. The muscles in my arms, my trunk, and finally in my legs gave
a few feeble jerks, then failed me, going completely flaccid. I
flopped back on the stretcher, not breathing, still as death, yet fully
conscious.

I caught my reflection in the large circle of stainless steel that
encased the overhead light. My eyes--open, unmoving, the pupils
dilated by terror--appeared unseeing and lifeless.

But I saw all too well, and the expressions on the faces of the three
who'd done this to me were chillingly indifferent as they leaned over
to check my pulse, to document my loss of reflexes, or to simply stare
down at the effects of their work.

Eighty seconds. It had sounded not so terribly long, like nothing much
more than holding my breath. But I had no breath to hold because I
hadn't timed my breathing properly, and when the succinylcholine
blocked my respiratory muscles, what little air I had taken in was lost
as my lungs deflated. The smothering pressure in my chest, unbearable
at the outset, increased steadily. In my mind I bucked and strained
against the grip of the paralysis, but my muscles remained slack,
useless.

I felt entombed, buried alive while locked inside my body.

"Ten seconds," the anesthetist said dryly.

It was beyond enduring. To be suffocating, and yet be so brutally
clearheaded. There was no welcome slip into unconsciousness, not yet.
I couldn't even close my eyes and escape the cruel scrutiny of the
three onlookers. What's more, my senses seemed unmercifully
heightened. I had to listen to the sounds of their breathing as I felt
the pain of no air encase my chest and crush in on me like hardening
cement.

Yet as horrible as it was, the ordeal was what the others had led me to
expect. What came next wasn't. Suddenly I felt burning at the back of
my neck and throat as vomit flowed up my esophagus from my stomach then
poured unopposed down my windpipe. Oh, my God! I thought in alarm.
The tea and toast I'd taken before midnight--it normally should have
been digested by now! But obviously not by my stomach, churning as it
had been on the levels of adrenaline I'd been pumping out all night.

"Thirty seconds," the anesthetist said, oblivious to the forming
disaster.

The food particles in my windpipe filled me with the horrific urge to
cough and gag, but the impulse went nowhere, the lifesaving reflex that
might have cleared my airway fully blocked by the effects
ofsuccinylcholine. Instead I lay there, enduring the convulsive
sensation of choking to death while being unable to move.

"Fifty seconds," the anesthetist intoned, methodically opening the
valve on the oxygen cylinders and readying the bag and mask.

My eyes, though unblinking, could still cry. I felt the tears forming,
welling up behind immobile lids and flowing down my cheeks. But my
vision was dimming, the lack of oxygen finally, and mercifully,
clouding my conscious state. Slowly I was freed from the sight of my
tormentors; slowly I lost feeling; slowly the extreme pain of anoxia in
my chest and limbs subsided somewhat. But the sensation of choking
remained intact. It kept coming in waves. And I could still hear.

"Seventy," a distant voice said.

I felt the anesthetist roughly extend my head and flex my neck, as
though forcing me to sniff a flower. I also could still sense enough
to know he'd plopped the mask onto my face, covering my nose and
mouth.

Then, from even farther away, I heard him mutter what I feared would be
my epitaph.

"Shit! The son of a bitch aspirated!"
Chapter 21

At first the darkness was absolute, admitting no trace of light. Nor
did sound penetrate to the levels where I floated.

I was neither conscious nor unconscious. Rather, I simply drifted with
only the most primitive of my senses--touch, pain, temperature--intact
and ready to be probed. But nothing was out there to impinge on
them.

Then suddenly I felt movement around me, and the blackness issued up
shadows for me to see. Immediately I accommodated, and acquired the
power of sight as the shapes approached, loomed over me, then
withdrew.

When distant voices broke the silence, sounding far off as if through
water, my sense of hearing developed next.

"Pulmonia ... asftxiar ... oxigeno ... medicamento .. .

antibiotico," a man was saying.

I tried to speak with him, but my throat clamped around something
caught in its midst and I immediately jackknifed at the waist, caught
in the clutches of a cough that wouldn't let go. My mind surged in
panic the rest of the way toward the surface, until I breached it and
remembered everything. My chest hurt, my limbs ached, and I kept
gagging, launching myself into another cycle of hacking while still
struggling to breathe. For a terrifying second I thought my lungs must
still be plugged, but when I finally gasped in a breath, the whooshing
noise in my ears made me realize that I was choking on an endotracheal
tube in my windpipe.
Then I did something really hard, and opened my eyelids. 509 I
immediately recognized the infirmary. Martinez was giving instructions
to a uniformed nurse at the foot of my bed.

"Sedativo," he barked, gesturing in my direction but barely giving me a
glance as he walked away.

No! Take the tube out! I tried to cry after him, but only managed to
produce a whistling sound, the inserted airway having bypassed my vocal
cords and rendered them useless.

The nurse picked up a pre filled syringe, leaned over the intravenous
line that was still in my left arm, and slowly injected me, until I
fell back into the darkness.

This time I floated between black and gray while the shadows continued
to come and go. Sometimes I felt them take my pressure; other times I
could tell they were administering medication, from the tugging at my
IV site. Whenever the sedation began wearing off I'd desperately want
to know what they were giving me. The proper antibiotics for a lung
full of vomit--clindamycin and a third-generation agent, such as
cefotaxime--had been nowhere evident in their medicine cabinet the
previous evening. Worse, I could feel a burning deep within my right
lung. Gastric juices are acidic and full of enzymes, as well as
bacteria. They not only infect the lung, they digest it. If the
anesthetist hadn't suctioned me out adequately, I knew I could be in
for a nasty, potentially fatal pneumonia.

Then all at once they'd inject me again, and I'd be too sedated to give
a damn.

As I yo-yoed back and forth, I couldn't regain any sense of time. Now
and then I recognized Martinez's voice. At one point I heard him
order, "Traiga su radio," and shortly afterward the tinny sounds of the
portable penetrated my netherworld.

"The voice of San Diego!" brayed a manic-sounding DJ.

"Bringin' ya hits from the D list with Dylan, Donovan, and the Doors."
Another sedativo, and I drifted off to the accompaniment of Dylan's
eerie "Ballad ofaThin Man."
The next time I began surfacing, my rise through limbo seemed to be
going quicker than usual. Like a diver coming up from the depths too
fast, I felt that something was wrong.

First of all, the place was deadly quiet. Next I realized that the
shadows were no longer coming and going in their ministrations.

And from the way I was coughing, I could certainly tell that they
hadn't sedated me in quite a while. My eyes flew open and I saw that
the room was empty.

Was everyone at lunch perhaps? But even the lights were off, and the
illumination from the only window in the room was so gloomy that it
suggested day's end.

Instinctively I raised my left hand to look at my watch, and was
startled to see blood seeping back into the clear intravenous tubing
from my arm. Glancing up, I saw that the bag suspended above me was
completely collapsed, having been allowed to run dry. What the hell? I
wondered.

Out of reflex I quickly reached overhead to turn off the flow valve.
But the attempt to raise myself from the bed shot my entire upper body
into spasms, and I flopped back with a shriek of pain. My muscles had
been so deprived of oxygen that, like a marathoner's at the end of a
race, they'd become full of lactic acid and useless.

Yet it was the hose in my throat that quickly became my biggest agony
when the remainder of the sedation rapidly wore off. I began gagging
on it again, and had to struggle through several tries at sitting up
before I got myself perched on the edge of the bed. Still retching, I
rummaged through the contents left by the nurse on the nightstand until
I found a syringe.

Quickly I connected it to a slim catheter flopping out of my mouth
alongside the larger breathing tube. Pulling back on the plunger, I
deflated the rubber cuff that lodged the device in my larynx and
extubated myself, with much sputtering and spitting onto the bed
covers.

My watch showed nearly two-thirty. The men I'd met last night would be
long gone, along with my chance to get a message to Janet. But where
was everybody else? I wondered if something had happened in the
standoff back home that had made them abandon the place, and me with
it.

I grabbed the radio and, using the earplug so as not to alert anyone
who might still be around that I was up, caught the news at the half
hour.

"The Siege of Brama," as the announcer now called it, was the lead
story.

"... the situation remains tense. From what we know to this minute,
none of the hostages has been injured. But apparently there are new
fears that the safety of Brama's president, Mr. William Baines, might
also be in jeopardy. Baines arrived in San Francisco on a commercial
flight just before noon, surrounded by armed guards, but instead of
proceeding to the site of his heavily damaged head office and holding a
press conference as his secretary had scheduled, he was promptly
whisked away to a private jet, which then took off to an undisclosed
location. It's rumored he's gone into hiding to foil a possible
attempt on the part of the PDL's ringleader. Dr.

Jack MacGregor, to take him hostage as well. But a company spokesman,
insisting on remaining anonymous, indicated that Baines is now flying
to the site of yet another Brama installation the PDL has targeted,
where he intends to intervene personally in the crisis. Hiding out, or
heading for a showdown, only time will tell. This is the voice of San
Diego ..."

I yanked out the earpiece and once more looked over toward the window.
As far as I could see, it wasn't raining, but an occasional flash
outside began to revive the familiar growls, sending them to new
volumes. The thin gray light had dimmed even further in the last five
minutes, until it seemed to be already nightfall.

"Oh, my God, Jack," I murmured, "what the hell are you up to now?"

Outside my door, during lulls in the rising noises of La Rumorosa, the
hallways were completely quiet. It was understandable that they'd send
most of their staff home, since there were no more patients besides me,
but this silence in that echoing maze seemed to be total, as if no one
at all was walking around anywhere. It became unnerving as I strained
to hear at least something in that soundless place, until I almost
welcomed the intermittent loudness of the storm to counter the spell.

Had they discovered who I was and simply abandoned me there to die?

I struggled to my feet and tested my legs. They nearly buckled, but
after a few attempts I managed to take a dozen steps. The effort
drenched my flimsy hospital gown with sweat and propelled me into
another spasm of coughing. Except this time the ever thicker sputum
was tinged with blood.

Alternately pushing my IV pole and leaning on it, I made my way
unsteadily to the nurses' workstation, where I picked up the phone and
tried to get an outside line. The call was instantly blocked by a busy
signal. I tried again. Same result. It was hardly a surprise.

I was standing holding the receiver near my ear and wondering if one of
the phones I'd seen in Martinez's office would be any different when I
heard the click of someone else coming on the line.

I instinctively held my breath. On the other end no such precautions
were taken, and I could easily hear the listener breathing. He or
she--it was impossible to tell--must have seen an extension light up
when I first tried to dial out. But who was it, and where in the
building was their phone?

"Shit, he must be awake," said a voice that I easily recognized
asVasquez's.

"Get him!" another voice in the background ordered before the receiver
slammed down in my ear.

With soaring alarm I ripped out my IV and stumbled for the doorway,
determined to try and reach Martinez's office before Vasquez could stop
me. But I was barely halfway across the room when I heard running
footsteps in the distance.

I froze and realized it was at least three people, and the footsteps
coming closer were louder by the second. Hide! my instincts
screamed.
I looked around but saw nowhere to go--not a closet, not even a
large-sized cupboard.

Praying there'd be a place in the hallway where I could conceal myself
in time, I hobbled the rest of the way through the infirmary, stepped
into the corridor, and glanced both ways.

It was still empty, but the steps sounded as if they were just around
the corner to my right. Wheezing heavily and trying like hell not to
cough, I wheeled left and started running.

Immediately I started to choke. As my hacking reverberated along the
walls, the steps behind me grew quicker still.

I kept going, heading for a series of closed doors about ten yards
away, but was so weakened and slowed by my breathing that I felt as if
I were moving underwater. If I could just fool them for a few minutes,
I kept telling myself as I got nearer the first entranceway. Make them
think I'd gone down another corridor. That's all the time I'd need to
get behind them and sneak back to the front office, where hopefully I
could dial Janet's number.

I reached for the handle and pulled. If it had been unlocked, I might
have made it inside. As it was, I was still tugging on it when I saw
Martinez, Vasquez, and William Baines turn the corner and head toward
me.

"Hurry up with that damned IV" Vasquez snapped at Martinez, who was
clumsily setting up a new intravenous set.

"The sooner we get this done, the better."

Martinez's bronze coloring paled to a sickly beige.

"Look, both of you, I am a scientist, a physician," he protested,
looking from Vasquez to Baines.

"I never agreed to help you do anything like this--" "What you are,
Martinez," Baines shot back at him, "is the greedy dumb fuck who let
Garnet in here. Now you're going to help get rid of him!"

The three men had hauled me back to the resuscitation room and tossed
me onto the stretcher. They then proceeded to dress me in my own
clothes, including shoes and socks.
As they manhandled me, my face was pressed into the rumpled sheets and
my nostrils filled with the sour aroma of stale sweat.

Baines paced as he ranted, his eyes staring darkly from the new folds
of puffy circles that he'd accumulated since last week. The
psychiatrist stood to my left, nervously unwrapping the cellophane from
a new intravenous set and trying, it seemed, to avoid catching my gaze.
Vasquez loomed to my right, not paying me the slightest attention as he
kept a vice grip on both my wrists with a single hand. Not that I was
in much shape to run off. Repeatedly I curled into a ball because of
my coughing, and the muscles in my legs were reduced to little more
than spastic knots, thanks to my premature attempt at a sprint.

Baines abruptly leaned toward me over the foot of the bed.

"You hear that. Garnet, you fuck!" he shouted.

"I head here to make sure our tracks are covered, and lo and behold, I
find you. That means you're a man without much of a future." His
haggard face reminded me of Jack's.

"And you look like a man who's not sleeping very well," I shot back,
albeit in a croak.

"Problems with the hired help?" I added, jerking my thumb toward
Martinez and nodding toward Vasquez.

Baines recoiled with a snort of surprise, clearly annoyed at my
insolence, and Martinez's jaw dropped an inch. But Vasquez started as
if I'd slapped him, and his face colored to crimson. I thought he'd
punch me as I watched him cock his fist and draw back his lip the way a
dog would to show his fangs. Good, I thought, figuring that I'd hit a
nerve. If he was defensive about his place in working for the
American, I could exploit that.

"Easy, Vasquez! Get control of yourself," Baines warned sharply.

"Remember, we have other plans for his face. It's got to look like a
fall."

Vasquez remained poised to strike for a few seconds more, eyeing me and
breathing almost as hard as I was, but he held back. Finally his
thick features transposed into a leer.

"That's right, we do have other plans, don't we?" he told me softly
through clenched teeth. But then he lashed out at Martinez, jabbing
accusingly at him with his finger.

"You and your nicking private patients!" he roared, unleashing the
fury that I'd stoked.

"I told you that bringing him here was crazy."

"We were on guard for terrorists," Martinez fired back, "not some wimpy
urologist from New York. Besides, you were quick enough to cut
yourself into the take."

They lit into each other in Spanish, going eye-to-eye across my legs.

"Shut the fuck up!" Baines shrieked at them.

"I can't believe you two! That maniac's launching an all-out attack on
us up north, everything we have is at stake, and yet you put us all at
risk to pad your pockets with a few extra grand..."

The two Mexicans stopped shouting at each other and glared at Baines,
both of them looking furious as he continued to give them a dressing
down, but they took it in silence.

I'd gone into another fit of choking and was straining to hear his
words. He must be talking about Jack, I thought, seeing the
frustration written large all over his face.

"... don't you realize what we're up against? He's bleeding us dry
with his blackmail--thirteen million I've paid him so far--but he may
still go to the cops. And his slicing Saswald's throat when I balked,
then Forbes's--he could do that to you, me, any one of us, yet you
haven't the sense to be careful--" "Thirteen!" Vasquez interrupted.

"I thought he'd extorted eight! You had to pay him another five
million?"

Their words hit me like a head-on collision.

Baines wheeled away and resumed his pacing.

"Yes, I had to fork over another five million. He started threatening
to expose this place--again!" he raved, waving his arms in the air.

I felt my universe start to turn upside down. All I could think was:
They couldn't mean Jack!
"Jesus Christ!" Vasquez muttered.

"You mean he milked you some more, then set his fucking PDL on us
anyway?"

Baines answered by pivoting around and screaming into my face.

"Your precious Jack didn't tell you that he was a blackmailing murderer
before he sent you here, did he?"

My mind went reeling for the sidelines, too sandbagged by what I was
hearing to think clearly. No, you're wrong! I wanted to scream, but
before I could recover enough to say anything, Vasquez suddenly pinned
my right arm to the bed with his knee, and I howled with pain
instead.

He threw the rest of his weight across me and grabbed my left arm with
two hands.

"Get on with it!" he barked at Martinez.

The psychiatrist's eyes bulged as he swallowed a few times.

"Listen, why don't we wait--" "Do it now!" Baines ordered.

Martinez swallowed once more, then took the needle he was holding from
its sheath and brought it up to a vein in my forearm.

"You bastard," I rasped at him while starting to struggle. But
Vasquez's grip was too strong. I felt the sting of it going in.

Martinez averted his eyes as he taped the line in place and started the
flow from a bag of saline.

"I'm sorry," I thought I heard him whisper when his head was near mine.
He then strode to the medication cupboard, picked up a glass
vial-succinylcholine, it looked like--and snapped it open. I gaped at
him as he deftly started drawing the contents into a syringe,
incredulous that he could be so absurd and obscene as to apologize
while preparing to kill me.

Suddenly Baines was at my ear.

"Give MacGregor to me, Garnet," he said, speaking softly.

"Besides you, he's fooled all those other poor idiots who he's got
poised to die for their loved ones. You owe him nothing now. All he
turns out to be in the end is a greedy con man on the take for himself,
using them as unwitting enforcers. Why, he's like a mobster running a
protection racket..."
My attempts to break out ofVasquez's hold had exhausted what little
strength I had left. As I lay there, helpless to resist and my mind in
a tumult, I still refused to believe what I was hearing. I also had a
fleeting hope of turning to my advantage his belief that I knew how to
locate Jack.

"... where is he, Garnet? Give me MacGregor, and I'll sedate you
before we do what we have in mind. Otherwise you're going to tumble
into that deep gorge beside the road out front while wide-awake and
full ofsuccinylcholine..."

To shut out the words I focused back on Martinez, only to see that he'd
finished drawing up a second syringeful from a smaller,
different-colored vial--midazolam, it looked like-and was walking
toward me. He held the cylinders of both needles upright in his hand,
their points glinting in the light.

The sight of the larger one was enough to send my heart pounding, and I
began taking extra gulps of air, to get ready for what was coming.

"... the fall won't necessarily kill you, but the lack of breaming
certainly will. The idea is that the rocks on the way down will rip
your skin open and bust you up inside while your heart is still
beating, so you'll bleed awhile. On autopsy it'll look like you died
from the trauma. Tell me where he is and you'll take the ride the easy
way."

"Too many people know why I came here!" I protested, desperate to stop
him.

"You won't get away with it."

"Oh really? We'll say that you sneaked in here under a false name,
wanting treatment. When Dr. Martinez kindly obliged, you got scared,
ran into the storm, and fell--your tragic end brought on by yourself,
the outcome of a misguided obsession with Brama. At least that's what
I'll tell the media, as well as suggest that since you were here as
part of MacGregor's terrorist group, maybe he sent you to blow up yet
another Brama building."

"That'll never fly!"

"It won't have to fly. Just float around, like a shadow of doubt."
I knew it was futile--trying to convince him that he'd be caught--as
though that would keep him from killing me. Yet, compelled by fear, I
continued arguing with him. If nothing else, my striving to make him
change his mind let me trick myself out of facing the inevitable, for
the moment, and helped me keep my panic in check.

"The police will go over this place with a microscope."

"We were eventually going to reveal what we're doing here anyway. The
publication of our work will be a little early, is all. And no one can
prove we killed Pearson or the others because they'll never find the
bodies. Someone finding yours, on the other hand, will add credence to
the story that the rest ran off."

"But why kill me at all?" I implored, barely able to speak, my mouth
having gone so dry. The instant I spoke and heard the pleading in my
own voice I thought, Oh, God, don't let me slide into begging for my
life and give him the satisfaction of that.

"After all, it's still just my word against yours," I added, desperate
to sound as if I were simply pointing out the logic of his sparing
me.

He gave a sarcastic snort.

"My dear Dr. Garnet, you know way too much! Combined with how dogged
you are, I'm afraid it makes you far too dangerous to be left alive.
Besides, even before you came here you'd made yourself a plague to my
company. You have no idea the added gratification my eliminating the
man who coined the charge 'no-fault murder' is going to give me. That
little ditty has become a PR nightmare for us. So how about it? The
easy way or the hard way?"

My skin grew clammy. Fight him some more! I screamed to myself. Argue
about something else; say anything at all to delay him and prevent me
from thinking of my own demise.

"You're wrong about MacGregor!" I shouted to keep him squabbling with
me.

He didn't bite.

Instead he looked up at Vasquez, who was still on top of me, and asked,
"Has everyone on staff been sent home?"
"Even the guards," the burly man answered, his grip tightening on my
left arm."

"On account of the roads and a risk of black ice," we told them."

"Then bind him down and let's roll."

Vasquez pushed. Martinez scurried behind, carrying the two syringes,
looking as dazed as if he were sleepwalking at a fast pace. Baines
strode alongside, an lago at my ear, continuing his effort to convince
me about Jack.

"... when the blackmail started after Pearson died, I was unable to
even imagine it was him--at first. Because all those years in San
Francisco when he'd been a thorn in my side, I'd at least believed that
his patient advocacy, though misguided, was sincere. See my point? If
he could fool his enemy, why shouldn't he be able to trick a
friend..."

His words became an echoing noise as the white walls and ceiling went
sweeping by my head, the landmarks from my entrance on the previous
day--the dining hall, the infirmary, the lab--flashing by in reverse.

"... so why protect a person like him? Look at his greed.

The demands for money were small at first, but when he killed
Saswald--the name "Pearson' may have stumped the cops, but I sure as
hell got the message that our blackmailer was the murderer--his price
became two million..."

Whether from our moving so swiftly or my beginning to hallucinate, the
ceiling tiles gave me the illusion of racing under an undulating
checkered flag. Fighting a surge of dizziness, I bucked with my torso
against my restraints and thrashed my head from side to side in an
attempt to break free, until my mind snapped back to the times I'd tied
David Pearson down and how he'd writhed to no avail before his hordes
of oncoming spiders.

".. at the height of the police investigation, particularly if they
were pressing hard, MacGregor kept demanding two million more. When I
balked and tried to bargain, he doubled his demand to four, and even
then said he'd just as soon cut my throat..."
At the main nursing station the lights had been left on, making it
appear as if they were expecting someone to return at any second. But
nobody came.

"... I still resisted, hoping that whoever it was, he'd slip up and I'd
nail him. But all I ever dealt with was a husky, disguised voice
calling from different pay phones in Buffalo--I know because I tried to
have him traced. Then he murdered Forbes and threatened me again with
more of the same unless I gave him six million. I paid--I was too
terrified not to--and I've been paying him virtually on demand ever
since ..."

Wait a minute, I thought. How could Jack have used pay phones in
Buffalo? But the question popped out of my head as quickly as it came.
Thinking such puzzles through wasn't something I could do right then.

Seconds later we were past the abandoned guard station, through the
automatic door, and out of the building. The daylight had turned as
murky as smoke, and we plunged into a wailing wind so cold that I felt
I'd been cast into ice water. Although the rain hadn't started again,
everything was coated-the pavement beneath us, the asphalt in the
parking lot, and the road ahead--with a slick, gleaming surface. We
rattled over the sidewalk, the stretcher sliding sideways and its
wheels nearly slipping into the black earth covered with weeds. Vasquez
cursed as he brought it under control.

Through it all, Baines continued his harangue.

"... when he called me this weekend, teasing, once more insisting he'd
reveal the secret of La Rumorosa unless I paid, he took great pains to
describe how he'd enjoyed watching Saswald and Forbes trying to talk
once he'd cut their heads half off. Believe me, I again wired the
money as soon as I could--to yet another offshore account--they're
always different..."

I stared straight up at the sky and tried to get control of my rapidly
unraveling nerve. Overhead a tree tossed its foliage like a mane as a
strong gust swept through it, rustling its wet leaves and making them
sound as if they ware concealing a thousand snakes. Baines had to
raise his voice.

"... face it, he's a sadist, a murderer, a blackmailer, an
exploiter--you've been used..."

I forced myself to tune him out, my mind still too addled to logically
tackle what he was saying anyway. But my gut instincts had remained
intact, and they held firm that it wasn't Jack. Because in the end,
whatever Baines was claiming, I knew that Jack's fierce sense of
justice would never let him surrender the high ground in his attempt to
be the nemesis of the man. He'd break the law to pillory Baines with
the PDL because he'd see that as righteous. And if he had resorted to
blackmail as part of inflicting punishment on Baines, he'd have done so
solely because hurting Baines in the wallet would be apt, not because
he'd want the money for himself.

But not for all the riches of the world would he ever debase himself
with killing, of that I was certain, for it would betray everything
he'd ever stood for as a doctor and, in this case, made him too much
like the man he was after. Jack simply loathed Baines far too much to
ever give him that kind of satisfaction.

Yet I only had to look at Baines's haunted expression to believe that
someone had put him through the hell he was describing.

If not Jack, then who? This question flew to mind like an arrow,
staying the chaos and galvanizing me into a few more seconds of
coherent thought.

We moved onto the smooth asphalt of the parking lot, passing behind
Martinez's four-by-four and the green BMW--the only vehicles there. How
had Baines arrived? I wondered fleetingly. Wherever the nearest
airport was for his private plane, he wasn't the kind to ride a bus.

As we neared the point at which the lot narrowed into the beginning of
the road, the grade sloped downward and Wasquez, sliding with every
step, had increasing difficulty controlling the bed in the descent. I
raised my head and could see the first of the drop-offs barely a
hundred yards ahead, the dark sweep of the mountains lying beyond it.

"... so tell me how to find him. Garnet," Baines once more cajoled.

"Let me bring him to justice. You owe it to your cause and all those
people he's deceived, and you'd be leaving the world with one less
serpent in it--" "All right! I know where Jack is," I lied, my voice
breaking as I made no attempt to hide how afraid I felt.

"But I don't want your thugs to hear me betray him. Come closer. I'll
whisper it to you. And then you'll put me out, right? You promise me
that? You'll put me out now?"

Baines looked surprised at hearing me beg.

"Sure," he said suspiciously, and started to bend down near my mouth.

"It's too slippery," Vasquez interrupted, bringing the bed to a stop
and setting the brake with his foot.

"If he goes over the side on a runaway stretcher, they're liable to
tell from the marks at autopsy that he was in restraints when he died."
He started unbuckling my legs.

"Here, help me!" he ordered Martinez.

"We're going to walk him the rest of the way."

Baines had paused with his head turned sideways about a foot above
mine, looking down at me the way a bird eyes a worm.

"Well?"

"Closer. It's hard to talk," I whispered.

He leaned down another six inches. Martinez was stepping toward
Vasquez and had slid the capped syringes into the pocket of his white
coat. It was fully buttoned, but napped noisily as its hem caught in
the wind. I whispered low enough that the continued snapping drowned
out my words.

"What?" Baines said impatiently, moving closer still.

I lunged at his ear with my teeth, clamped down on skin over cartilage
and wrenched.

I felt it give.

Blood spurted over my face as Baines's shriek filled the air.

His fist shot into my upper gut, exploding the breath out from my lungs
and releasing my jaw.
He reared back, his hand cradling the half-severed appendage as blood
continued to flow out between his fingers.

"Son of a bitch!" he roared, his voice full of terror.

Martinez and Vasquez remained where they stood, mouths open,
expressions of shock frozen on their faces.

Baines continued screaming.

"Christ! What have you done to me, you bastard!"

Martinez moved first, grabbing a handkerchief from inside his coat as
he stepped up to Baines and forced the man's hand far enough away from
the tear that he could wedge the white cloth against it.

"You'll need a plastic surgeon to repair that," he said loudly over the
howling gale and Baines's cries.

"That's right, asshole!" I yelled.

"You're going to need an ER. But out here, hours from anywhere and
with the roads slippery as hell, your only sure way of getting sutured
in time to save it is with me. My life for your ear! How about it?
Unless of course you'd prefer going through life doing a Vincent Van
Gogh imitation." I knew he could have me killed the second I finished,
but for the moment I seemed to have gotten enough of the upper hand to
win at least a temporary reprieve.

Baines appeared to get a grip on himself--he had stopped bellowing like
a wounded animal--as Martinez's improvised compress slowed the
bleeding. Still grimacing and moaning, however, he reached with his
free hand inside his jacket pocket, took out his cell phone, and pushed
a single redial button.

"Get ready to take off and set a flight plan for San Diego," he ordered
into the mouthpiece.

"Have an ambulance meet the plane. I'm going to need a hospital. I'll
be back up at the strip in twenty minutes..."

"It's our private airstrip near the American border," Vasquez taunted
me from behind my head.

"I guess loose-lipped Martinez forgot to brag about it."

Baines finished talking, then watched me deflate in front of him. Even
with his face etched in pain and covered with blood, he managed to look
triumphant as he enjoyed my defeat. Behind him loomed the half-built
structure of the creation he'd soon unveil to the world, its dark ribs
pointing skyward against the massing purple thunderheads. Except in
the thinning light it might just as easily have been taken for an
abandoned ruin left to rot, like the carcass of some prehistoric
mammoth.

"You know. Garnet, it's guys like you who inspire guys like me to come
up with ideas like this," he said, gesturing over his shoulder.

"Because I figured that sooner or later the zealots on your side might
just win the right-to-sue argument, and we could lose the one percent
margin we now enjoy. That prospect drove me to come up with another
moneymaker-in this case, it's aversion therapy. Brama's share of the
savings alone in treating alcoholics will move at least eight billion
from expenditures into our profit column. In other words, as you go
over the edge. Garnet, know that the very cause you're dying for has,
in a way, instigated our creating everything you've seen here, and a
huge boost in earnings to boot. Kind of makes your sacrifice seem a
waste, doesn't it?" He paused, then softly ordered, "Do it the hard
way," addressing Vasquez while continuing to eye me.

Helpless under his stare, I tried my damnedest to keep from shaking in
the cold. It suddenly mattered to me that he not think I was trembling
because I was afraid.

"Also, you better clean him up," he added, "in case the cops get
creative and do something smart, like analyzing the blood on him."

Vasquez shrugged.

"Why bother? It'll rain soon, and cops in La Rumorosa aren't exactly
world experts in DNA testing."

"You'll do as you're told," Baines snapped, and strode back toward the
building.

I raised myself up, craning to watch where he went. After crossing the
parking lot, he passed the sidewalk and kept walking until he reached
the far side of the sprawling edifice, where he disappeared around the
corner.

The two men finished undoing the straps and yanked me off the table.
Neither made any attempt to get Baines's blood off my head. Vasquez
pinned my arms from behind and, with Martinez holding the IV bag aloft,
frog-marched me the remaining hundred yards along the roadside where
the footing was better.

I struggled every step of the way, then dug in my heels when they
veered me toward the edge of the drop-off. But I remained weak as a
kitten, and my efforts only managed to set off another round of
coughing. Within less than a minute I stood shivering in the
half-light between the two of them, looking down a steep rocky grade
about two hundred feet high while the wind slammed into us with the
force of a wave.

I sought refuge from seeing where I'd fall by closing my eyes. In that
private darkness the shrill sound of the gale filled my ears, inviting
me to leap into it with arms spread wide, to let it carry me up and
away from there. I grasped at the fantasy, and had the fleeting
illusion that there was charity in letting the condemned retreat into
the blackness of a hood during the final seconds.

I sensed Vasquez reach across my chest to Martinez, who bracketed me on
the right.

"Give me the needles," he ordered.

My fantasy of flying crashed. My legs buckled. My brain dived to the
level of a terrified animal's. I opened my eyes in time to catch
Vasquez lifting both syringes from the psychiatrist's pocket.

"Which one's the succinylcholine?" he asked.

"Martinez, for Christ's sake!" I blurted, suddenly desperate enough to
want the easy way out.

"You're a physician. At least put me under!"

"The smaller one with two cc's in it," he replied to Vasquez,
continuing to stare straight ahead, looking at neither of us and
swallowing about once a second.

That was the midazolam.

Vasquez studied the smaller syringe, and then Martinez's profile.

"You lying wimp," he snarled.

"I've seen what they've used often enough." Without ceremony, he
shoved the larger needle into the injection portal and brought down the
plunger.

Within seconds I felt the tingling rising up my arm.
"You bastards," I screamed, my heart rate shooting into triple
digits.

Martinez jerked his head around, finally looking me straight in the
eye.

"I'm so sorry," he repeated, his voice breaking while he still kept a
firm hold on my wrist.

"But they'd have killed me." His pupils grew tenfold with fright and
his face distorted as if he were about to weep.

I spat at him. Except I had no spit.

Vasquez roughly yanked the tubing from my vein and flung the entire
infusion set on the ground. Grabbing my other arm from Martinez, he
once more pinioned me from behind and adjusted his stance, readying
himself. For an instant we stood there, as three men might stand on a
platform waiting for something as inconsequential as the next train.

My legs sagged again. Vasquez cursed something in Spanish, but held me
up. Martinez abruptly turned away, his shoulders shaking, and I
thought I heard a muffled sob. Then I felt the tingling pass up
through my shoulders to my neck, and I started gasping in air as fast
as I could.

My name floated to me from behind, faint against the wind.

At first I thought it was a hallucination, but I heard it again.

"Gaaamet! Gaaamet!"

I swung my head toward the sound just as the muscles in my shoulders
started to quiver.

I saw figures running down the road toward us. Accelerating in front
of them, riding the stretcher on his hands and knees with his coat
streaming out behind him, was Jack hurtling at me, his face a howl of
rage.
Chapter 22

Vasquez's grip on me shifted as he and Martinez also turned toward the
sound.

"What the hell?" Vasquez exclaimed when he saw what was heading toward
him.

The fasciculations reached my legs. Knowing I'd be paralyzed in a
matter of seconds, I deliberately dropped to the ground, becoming a
dead weight in Vasquez's hands.

"Shit!" he exclaimed, stumbling with the unexpected load.

He gave a quick heave, partly tossing, partly rolling me toward the
edge until my legs dangled over the chasm below.

Clinging to the rocky shelf, I dug in with my elbows and wiggled my
torso, quickly gaining the inches needed to be more on than off. I
kept scrambling and clawed up a foot more, all the while still trying
to gulp in extra air. I raised my head in time to see Vasquez reach
inside his coat and bring out his gun.

"Look out!" I screamed at Jack, who was hurtling nearer by the second.
He'd already pulled himself into a surfer's crouch, the loose bed
sheets billowing up around him as he drew a visual bead on Vasquez and
prepared to jump him.

But as the gap between the two men closed, Vasquez leveled his pistol
to fire.

The paralysis hit, my head dropped, and the right side of my face
plopped into the dirt. My breath ran out of me as softly as a sigh,
blowing a fine dust into my still-open eyes, which I couldn't blink,
and the squeezing sensation in my chest began to build. But it was
when my lower legs flopped 328 straight out behind me, still in
midair, that the shift in weight made me slowly lose my perch and I
started to inch down.

The rattling of the stretcher sounded almost on top of us.

"Noooo!" I heard Martinaz scream above a roar from Jack.

Then a gunshot blasted over my head.

Martinez's shouting trebled into a screech, and Jack let out an even
louder bellow. I heard a thud, followed by snapping twigs, scraping
stones, and a stream of curses from Vasquez.

The clattering of the stretcher grew so close that I was convinced the
heavy steel table would bash into my head, then I felt its wheels brush
along my right side as it raced by, and I heard it no more.

Martinez continued his shrieking, leaving me desperate to know what was
happening as I continued to slide. Dirt grated against my chin. A
salty metallic taste filled my mouth as tiny stones pulled my lip into
a sneer and abraded its inner lining.

Bristly tufts of underbrush and other potential handholds slid
tantalizingly under my palms. But most of all I felt the pain of
having no air, and it kept mounting.

Behind me, far below, I heard a distant crash. From above, Martinez's
cries became a terrible gurgling noise, while sounds of punching and
grunting replaced Vasquez's cursing. Floating over it all came the
shouts of the people who'd been running after Jack as they drew
closer.

Friends or foes? I doubted I 'd have time to know. My descent
quickened, and the rocky edge I was sliding off had already cut into
the top of my thighs. It bit into my pelvis next, giving my bony
prominences and other vital appendages a good scraping as they passed.
Then my legs dropped straight down, and for a few seconds I teetered,
the sharp stone digging into my waist, the approaching footfalls and
shouts growing louder.

"Get him off me!" Jack hollered.

"Grab his fucking gun!" someone else yelled.

"I'll get Garnet!" a third voice volunteered.

But I slid again, this time all in a rush, and over I went.
I dropped like a rag doll, hitting the first narrow ledge of rocks ten
feet below, and remained there, collapsed in a heap.

Had I been a foot farther out or struggling to keep my balance, I doubt
I could ever have stopped myself on such a small outcrop.

The next seconds seemed like an eternity as the agony in my chest grew,
yet I was still conscious when Jack rappeled down, suspended from above
by the bed sheets tied in a loop under his arms.

"It's okay. Garnet, we've got you," he reassured me, purchasing a knee
hold beside me on a space little more than twenty inches wide. Gently
supporting my head and neck, he unfolded me, laying me faceup with my
back on the stones, and, sealing my mouth with his, he blew the
delicious relief of air into my lungs.

After four quick puffs he settled into a regular rhythm, his face
looming over mine. I could see that his sleep-starved eyes and gaunt
features hadn't improved any, but he was clean-shaven and there wasn't
so much as a whiff of alcohol on his breath.

"You and I... have some repair work... to do up top," he informed me
between respirations.

"That crazy Mexican in a white coat... stepped in front of a bullet for
me... and I think the least we can do for him... is to save his
life."

He settled into breathing for both of us. I began getting used to the
idea that I was going to live. But instead of relief, I felt shame. In
those last few seconds they'd broken me, snapped my will like a twig.

La Rumorosa gave a menacing growl, and the rain, driven by the wind,
started to pelt us. Jack tilted his head back and glared defiantly at
the heavens.

"Oh, shut up!" he yelled, then flashed me a grin as bright as the
lightning that was branching sideways across the sky above him. I felt
my courage surge back at the glory of that smile, the way it always had
whenever, in the middle of a hopeless case, his own crazy confidence
and fearlessness had ignited the same in me. And the sight of
him--cocksure, balanced on that tiny ledge, keeping me alive breath by
breath as the rocks beneath us vibrated so much in the storm's roar
that I feared they'd shake loose-was enough to make me believe that,
together again, we'd have the knowledge and nerve to win this thing.

Minutes later a shiver rippled through my muscles, and the paralysis
was gone, leaving me once more convulsed with coughing and shaking with
chills. Jack eyed the thick yellow sputum I was hacking up.

"Jesus Christ, man," he exclaimed.

"Have you got pneumonia--" "Jack, they've killed six people here," I
gasped.

"That's the real secret of this place, and we can charge Baines, plus
his cronies, with murder!"

He started, his eyes shooting wide in amazement.

"I knew it! There had to have been deaths," he exclaimed excitedly,
"but we never could prove anything. Even our sources inside Brama who
tipped us off about the clinic couldn't find evidence to crack that
damn lie about patients running off and subsequently dying of
alcoholism--" "Look, Jack, I've got a witness who I think I can
persuade to talk," I told him through chattering teeth.

"He's the one up above with a bullet in him."

Four of Jack's men used the bed sheets as a litter and rushed Martinez
to the resuscitation room. Red foam was bubbling up from the
psychiatrist's lips each time he exhaled, and his face had grayed to
the color of ash. All the hideous noises he'd been making previously
had petered into weak, incoherent whimpers.

As Jack trotted alongside he eyed a pair of crimson stains on the
psychiatrist's white coat--one expanding over the right upper chest,
the other spreading out in an enlarging circle from his back, but lower
down. By the time we reached the parking lot the stains had joined to
become one.

"A bank shot off a rib going in, and the exit wound a foot below," he
commented, determining that the bullet had ricocheted downward,
traveling the length of the lung and creating a much longer path of
destruction than if it had passed straight through horizontally.

As good as Jack's and my ER skills were, I knew Martinez needed a
thoracic-vascular surgeon and an OR within the hour.

"Maybe we can stabilize him, then fly him out of here," I puffed, the
brisk pace uphill taxing me heavily and forcing me to speak in short
gasps. My previous burst of confidence was waning fast.

"Sounds like a plan," Jack acknowledged, his voice filled with the easy
calm I'd always heard him adopt in the worst of times.

"My plane's still at the strip, the crew keeping Baines's pilots
company." But a frown capped his face when he looked back to where I
was struggling to keep up.

"Are you going to be okay?"

"Sure!" I bluffed, forcing myself to speed up and pull abreast of him.
I grinned through the pain as my muscles rebelled, but my wheezing gave
me away.

He shot me his best Yeah, right! look, yet said nothing.

When we reentered the building, it seemed that every phone in the place
was ringing.

"What the hell?" I exclaimed.

"Media," he said curtly as we scurried over the checkered floor.

"The minute we touched down, our people back home issued a communique
saying we'd seized the clinic and would be making a further statement.
We intended to expose that Brama was basically torturing patients here,
the disclosure hopefully adding so much to the company's infamy that
this clinic would become a symbol of all their wrongdoing."

"But that means the police will already be on their way as well!"

"Afraid so. It was all part of our campaign. We knew they'd show up
anyway, with a vengeance--cops don't negotiate with terrorists down
here--so we needed to give the TV reporters a chance to arrive first.
Except the storm's made it unlikely any newscasters will be flying in
anytime soon, and of course we sure as hell didn't expect to find you,
not after I warned you to stay away, nor Baines, especially since we
moved up the date of our attack--" He broke off, suddenly speechless as
he gawked at the austere surroundings.

"Jesus Christ!" he burst out.

"Who the hell decorated this place, Stalin?"

As I led the way, he stopped clucking in dismay and resumed briefing me
on his strategy.

"We meant to declare a twenty-four-hour deadline on Brama to settle up,
and figured cameras would keep the local cops and Federales in check,
giving us the time we'd need to continue broadcasting our case to keep
up the pressure. Otherwise the forces of law and order in La Rumorosa
might have turned our stand into another Waco before we even got
started." He added a sardonic chuckle.

"Hell, they still might."

"What are you talking about? I thought you just agreed that we get out
of here!" I was still short of breath, as we were practically
running.

He gave me a hard glance, without slowing down.

"Think about it. Garnet! If we can't keep your pal here alive, or he
doesn't give the testimony you'll need, there's no reason for any of my
people to abandon our original plan. In that case, we'll all be
staying put with our captives until either Brama accedes to our demands
or the deadline passes. Except at this site I'll have Baines as a
hostage instead of the psychiatrist, which is even better."

"And if Brama doesn't capitulate when your deadline runs out?" I
asked, dreading what he'd answer.

"Don't worry, we may never get that far. If Martinez dies, then once
word gets out the police will probably assume we shot him, no matter
what anyone says. I think in that case we're likely to kiss our asses
goodbye well before any deadline of ours is up, at least in La
Rumorosa, even (cnn is watching."

His flippancy made the prospect sound all the more chilling.

It was also a hedge against giving me a straight answer.
"Jack, please, be serious."

"What do you think we're going to do if Martinez doesn't come through.
Garnet?" he snapped, a look of contempt abruptly curling into his
darkening face.

"Like I've said all along, none of us is afraid to die. Some may go by
their own hand. As for the others, let's just say if the police did
come in shooting, they'd be doing most of us a favor."

"What do you mean?"

"Use your imagination, man! Those of us who can't do it ourselves, we
intend to provoke the cops into killing us. Hey, it's the latest fad
in L.A."

Even though from the beginning I'd feared that Jack was mounting a
suicide mission, to hear him admit the method of it so callously left
me feeling sick to tears.

"Why?" I forced myself to ask, my voice croaking from a throat that
had suddenly gone dry. Though I'd already figured out his reasons from
our encounter in Buffalo, I had a desperate hope that my forcing him to
explain such an atrocity would somehow make him face the insanity of
it, and he'd recoil from the idea.

"To cause public outrage and unleash it at Brama, Garnet," he replied
with an easy coolness that implied I should have known better than to
ask.

"A public outrage of such a magnitude that the company will never
survive it."

I hurried along in silence after that, unable to think of anything to
shake the hardness of his resolve. It didn't help my plummeting hopes
any when Martinez's blood started to drip through the sheets, leaving a
brilliant red slash across the black and white floor.

For the next quarter hour Jack was the doctor whom I'd known of old.
Before we even rolled to a stop and deposited our cargo on a stretcher,
he'd pried the man's airway open with a laryngoscope, suctioned off a
head of bloody froth that was rising up from the back of the pharynx,
and with ease slipped a tube into the trachea.

"There's a carotid pulse, but barely," he calmly reported as he
palpated the neck.
That meant a pressure not much over sixty.

Having already dug out infusion sets from the wall cabinets, I had one
in Martinez's left arm and was starting another on the right.

"Does that flying hospital of yours carry 0negative?"

We could give him all the volume of saline we wanted, but he'd
hemorrhaged too much to ever survive a flight to San Diego without
blood.

"Six units," Jack answered, hooking up the oxygen.

We both knew it would be barely enough.

He grabbed yet another intravenous set and proceeded to slip a
large-bore needle into the veins under Martinez's left clavicle. A
minute later we also had saline rushing into him through a pair of IVs
in his groin and I was checking his pressure with a cuff and
stethoscope. Seventy over zip, I got, and a pulse hammering at 130. By
jacking up his legs I won a few points more, when a particularly loud
boom of thunder set the room rattling.

Jack was hunched over the right side of Martinez's chest.

"Jesus, is it always this bad?" he asked without looking up.

With a small lurch he shoved a chest tube between the psychiatrist's
sixth and seventh ribs. Seconds later it was evacuating a liter of
blood from the pleural cavity into a suction bottle, restoring a space
for the intact segments of his lacerated lung to expand into as they
filled with air. I helped things along by grabbing a ventilation bag,
hooking it up to the endotracheal tube, and pumping hard. Now at least
we'd oxygenate what blood the man had left. But it was time to move
again. We'd done what we could for him here.

Jack snapped off his gloves and pulled out a cellular phone.

"We've got a gunshot wound for you," he said into the receiver.

"Will you to be able to get him out of here?"

I quickly rechecked the pressure. Repeated boluses of fluid had lifted
it into the eighties.

"... are Baines's pilots giving you any trouble..."

But this was the crucial moment. Sometimes our draining off blood from
a bleeding lung only served to dislodge clots and increase the rate of
hemorrhage, causing the pressure to drop.

"Rev it up. We'll be there in twenty minutes," Jack declared.

Then he eyed me and added, "I'm also sending you a walking corpse who
claims he's a doctor but is too stubborn to lie down. Make sure he
gets clindamycin, then cefotaxime, and put it on my tab."

I took Martinez's pressure a third time. It was holding.

At the front entrance the light had dimmed further, casting everything
in gray, and the storm was hitting us with all its fury. We had
Martinez once more on a litter of sheets supported between four men,
but this time a fifth person was holding his IV bags up in the air and
I was bagging him, a portable bottle of oxygen tucked in among his
covers.

I'd had no success trying to convince Jack to abandon his idea of
remaining behind. On our way out of the building he seemed to take a
disturbing amount of pleasure in having Vasquez and Baines as hostages,
glaring down at them lying propped against a wall in the corridor near
the empty guard station. Both were bound with masking tape at the
wrists and ankles, while someone had also applied a dressing to
Baines's torn ear, having wrapped the entire upper half of his head in
gauze until he looked like a partly clad mummy. They'd stared back up
at us as we passed, but where Vasquez was sullen and silent, Baines's
lips quivered under our scrutiny and then he sniveled at our backs,
begging, "Please, Dr. Garnet, don't leave me here with MacGregor. Have
pity. Take me with you." He broke into a series of uneven sobs after
that, wailing, "And what will happen to my ear?"

A look of distaste had crossed the face of Jack's sixth man, who was
holding Vasquez's gun on the pair.

"Shut up," he growled.

We'd taken no more than a few steps outside when we pulled up short. In
the distance a line of red and blue flashing lights was snaking up the
road toward us.
"About a mile away," Jack said softly.

"And moving slowly," I added.

"Probably because of the slippery roads. Still, they'll be here in a
few minutes."

The others eyed the scene below in grim silence.

"You head for the plane," Jack said bluntly.

"I'll keep them busy when they arrive. Otherwise you'll never make it
carrying Martinez."

"No, Jack, let me stay. They won't hurt me, and I can fool them into
thinking you're still inside the clinic--" "No more arguing about my
staying, Garnet. We've already been through that. Besides, from a
practical point of view, you're the one with the best chance of getting
Martinez to talk, presuming he lives. How could I hang around a
hospital trying to convince him to do the right thing without the cops
nabbing me and sending me to jail?"

"Jack, you said yourself, these guys don't negotiate--" "Head for the
plane, damn it!" he ordered his men, ignoring me.

They nodded and, without a word, began moving off, making it necessary
for me to step away with them if I was to keep bagging Martinez.

"Jack, this is crazy--" "Shut up. Garnet, and listen!" he barked,
walking alongside.

The look in his eye was steel.

"As soon as I go back inside I'm going to answer one of those goddamned
phones. I'll announce that we're about to produce a witness who can
testify that Baines and his company were committing murder here. I'll
also issue a statement instructing all my people to stand down as soon
as it's confirmed that the witness has survived and given the necessary
testimony to have charges brought against Baines. Anything less,
there's no deal, and the PDL reverts to its original strategy. Is that
clear?"

Swallowing hard, I nodded.

We'd reached the path leading to the airstrip, and Jack continued to
talk as we turned and started along its narrow, pebbled surface.

"One more thing. I don't know what's happening back in your hometown,
but from what I could find out, none of my people had anything to do
with the murder of Saswald and Forbes. And as far as this blackmail
stuff that Baines was going on about--I take it you heard it from him
too?"

"Yeah," was all the response I could muster as I desperately racked my
brains for a way to make him get out of there.

"I have no idea what that's about either, except that it must be part
of some other game that's afoot. So you be careful, Garnet, once you
get back, until you find out what it is."

"Look, Jack," I protested, "leave Baines andVasquez, grab Martinez, and
run for it. Take Baines's plane and make the pilots fly you somewhere
safe."

"No!" he shot back, his face again clouding over with anger.

"For the last time, stop bucking me on this!" And he drilled me with
eyes so black and scathing that it was all I could do to keep from
looking away.

"You and I, Garnet, we're out of time," he added, his voice all at once
soft and imploring.

"The least you can do for me is quit pretending that I can somehow cut
out from here."

"Jack, for God's sake, listen to reason--" "Damn it, man! One reason I
can't back off is because I have nothing left but this fight, and you
know it! So please spare me any more crap about my getting away.
Bullshit like that only makes what I have to do harder."

In the ensuing silence between us he held me with that searing gaze of
his. It was such a window to his torment that I found it painful to
endure, yet I sensed that he wanted me to peer through those unblinking
fathomless pits, in order that I might bear witness to what resided
there. Reluctantly I returned his stare, and in its depths thought I
saw such an obsession with taking this business to its conclusion that
I felt certain it had him in a death grip from which I could never free
him.
Yielding to his wishes, however reluctantly, I surrendered to his
despair, and felt as though a cold fist grabbed me around the heart.

He, on the other hand, took a few deep breaths and appeared to compose
himself until his expression unfurled, the way a man might after he'd
finally been relieved of a heavy burden. But his steely regard
remained.

"And just so you're forewarned, in case you want to distance yourself
from me when you talk to the police, if Martinez doesn't make it,
whatever justice is dealt out in this place, I intend to make sure that
Baines and his thug get a piece of it."

"Oh Christ, Jack, no--" "Hey, Garnet, whether it's through Martinez or
the PDL, I'm making certain that both Baines and Brama are finished.

With any luck, their fate should give every other HMO in the land that
was scrambling to be just like them serious second thoughts about
changing the way they do business. You want to guarantee nobody dies
in the process? Then make sure Martinez talks. Now move out, finish
the job, and don't let me down."

With that he turned away and strode back toward the building, his coat
blowing in the wind.

"Jack, wait!" I called after him, stumbling backward on the trail as I
kept up with the others and continued to bag Martinez.

He gave me a wave without turning around.
Chapter 23

Hunched low and leaning into the wind, the six of us stumbled along
with our passenger, the rain stinging our faces like needles. Overhead
great varices of lightning snapped across the sky, coloring the jagged
landscape a molten yellow that left us half blinded in its nicker. Then
we'd plunge back into a brown-gray limbo the color of rock.

And all the time, we kept looking back, expecting to see the Mexican
police racing after us.

The small jet had its engines running, and one of the pilots was
leaning from the door, waiting to lend a hand lifting Martinez on
board. Even stationary, the plane was rocked to and fro in the wind.

"Can we take off in this?" I asked incredulously as we transferred our
patient to a stretcher that was welded to the floor and strapped him
in.

"We'll soon find out," he replied with a grin, turning back to secure
the door.

Oh, Christ, I thought, having dreaded every commuter flight I'd ever
taken, and busied myself strapping Martinez in and hooking him to all
the banks of I.C.U equipment that lined the walls of the converted
passenger compartment. Only when I inadvertently glanced up and saw
one of the other men start down the retractable stairs and the rest
waiting to follow did I realize they weren't coming with us.
"Wait a minute! Does Jack still expect you to stay?" 540 "It's what
we want to do, Dr. Garnet," the next man on the steps quietly informed
me, "as testimony to the ones we lost."

"And to make sure Jack isn't alone up here," the fellow behind him
added, his eyes and cheeks gouged hollow with the same haunted look I'd
seen in the face of Robert Delany's father.

The five of them ranged in age from a young man who couldn't have been
more than thirty to a balding, lean gentleman who had to be at least
sixty, and they all had features similarly laden with grief. The
revelation startled me. Until then I'd only exchanged brief
instructions with this nameless group as we'd gotten Martinez safely
along the trail together, and had been too preoccupied to see the
torment that drove them.

"Please, for God's sake, don't go back. It won't accomplish anything,"
I protested, recognizing in their empty stares the kind of cold calm
that was often a prelude to suicide. None of them paid me the
slightest heed.

"Gotta go!" the pilot snapped, wresting down the door and levering it
sealed as soon as the last of them were out. Seconds later we were
taxiing to the end of the runway, passing Baines's plane where it sat
parked on the sideline. I could see two men watching us from its
well-lit cockpit.

"What about them']" I called to the pilot, who'd finished buckling
himself into the captain's chair and bad taken over the controls from
his partner.

"From what they told us, I think they're just air jockeys who don't
want any part of Baines's trouble," he shouted, bringing the plane
around to face into the wind and shoving the throttle forward. The
light craft shot ahead. Above the roar of the engines he added,
"They'd be hightailing it out of here now, if they had the guts."
Seconds later he pulled back on the wheel and we lurched up into the
air, then slammed into a sharp right turn with all the g-forces of a
roller coaster ride.

"California, here we come!" I muttered as I steadied the wildly
swinging IV bags and turned my attention to Martinez.
* * *

By the time we sighted San Diego Airport, I'd started him on the last
of the plasma. Before we even touched down on the runway I was doing

CPR.

"We've got a welcoming committee," the pilot declared as he finished
taxiing off the landing strip and pointed us toward the flashing lights
of the ambulance waiting at the edge of the tarmac. Nearby, a clutch
of media vehicles was surrounded by a crowd of people with cameras and
microphones. They in turn were cordoned off by an equally large mass
of blue uniforms.

That they all were waiting for us, I figured, meant that Jack must have
given his interview while we were in the air.

When we rolled to a stop, a pair of paramedics leaped aboard and the
police kept everyone else at bay.

"How is he?" screamed one of the reporters as we hurriedly transferred
Martinez to the waiting ambulance.

"Not good!" I yelled, continuing to pump his chest and ventilate his
lungs.

Our mad dash through evening rush hour bounced us around nearly as much
as the plane had. The only time I looked up, we were hurtling toward a
busy intersection against the traffic and accelerating as we went,
sirens screaming at full blast.

Within three minutes of our arrival in emergency, the ER doctors had
his chest open, a resident was pumping his heart with her hand, and he
was on the way to the OR.

"He's got a pulse!" she called out hopefully as the elevator doors
closed behind her.

"I think we better have a look at you as well," the Chief of Emergency
hurriedly insisted, walking over to where I was slumped, wheezing and
coughing, against the corridor wall.

After a quick listen to my chest with his stethoscope, he ordered me to
bed and arranged for a technician to X-ray my chest.

"By the way," he said with a wink, "Jack MacGregor has a lot of friends
in this department, and that means you do as well."
5Five minutes later he was holding my films up to the viewing screen
and raising his eyebrows at a white patch the size of a tangerine in my
upper right lung.

"Clindamycin and cefotaxime, I'd think?" he said, as if I were a
conferring colleague and not a patient at all. It's the way doctors
often behave when treating other physicians.

"That'll do just fine, thanks," I replied, grateful that he obviously
knew what he was doing, and within minutes one of his nurses had the
infusions up and running.

I used the next few minutes to make a collect call.

"Long distance from San Diego, California," intoned the operator.

"Do you accept a person-to-person collect--" "Yes! Yes! Yes!" Janet
shrieked.

"I'm out, and I'm okay," I told her quickly.

"But I'll have to phone you back. A pile of people are waiting--"
"They'll just have to wait," Janet declared, her voice cracking.

"Oh, my God, I've been frightened out of my mind since this morning
when the news about the PDL broke, and then about La Rumorosa. I even
called Riley. He was so upset by what was happening that he was going
to fly to Tijuana--" "Janet, it's okay now, and I'm fine--" "Plus I
heard Jack's interview just now. I was so wrong about him."

Police officers had started to gather around my bed.

"Janet, I've got to go. I'll call you back."

She gave a long sigh.

"Damn you. Earl Garnet. You better.

And be prepared for a long conversation."

"That's a deal. I love you."

After I hung up I got to talk with more people wearing badges than I'd
ever want to see again in a lifetime.

Martinez had recovered consciousness after surgery, barely, but after a
few words from the hospital priest, he indicated that he was ready to
make what his doctors and all the readings on his monitors predicted
would be a deathbed confession. He'd
also requested that I be present, and I readily consented to be
brought to his room in a wheelchair.

Still intubated and unable to speak, he managed to scrawl an admission
that his treatment had led to the deaths of six Americans. To my
surprise, those deaths had been significant enough to him that he'd
carried the people's names in his head, the way most physicians, myself
included, might remember for life their patients who'd died on account
of an error in judgment. For each case he was also able to list the
anesthetist who'd been in attendance. The sixth and final pairing on
the paper read davbd pearson-hector saswald.

When he finished, he waved me to approach his bedside.

Reaching for my hand, he made an attempt to beam me that million-dollar
smile, but the black tube sticking out between his lips rendered the
attempt pathetic. Before I could recoil from his touch I realized he'd
slipped me a tightly folded piece of paper. Then the priest moved back
in and I was dismissed.

Out in the hallway, with the holy man's incantation still audible
behind me, I looked at what Martinez had written:

I've not much time left. Dr. Kane. At least I had a moment of
courage in me after all. Maybe you helped me find it.

Don't be so stupidly righteous now as to completely ignore my work. It
could save lives!

I crumpled the note into my fist, as furious at its content as I was at
its effect on me.

Let the priest forgive you, I thought, unable to find any mercy in my
own heart. As far as I was concerned, there was no redemption in a
torturer trying to flush his soul clean at the last minute. And his
so-called work would get no help from me, not that I'd be able to keep
it from the plenty of others who'd be willing to take a look at it.

Monster that he was, however, there was no denying his having taken a
bullet for Jack. Yet even this redemptive act failed to temper my
judgment of him any. If anything, I resented the incongruity, and the
way it left me uneasy over the depth of my inability to forgive the
man.

I was still slumped in the wheelchair when a voice startled me from
behind.

"You look like you could use a friend."

I glanced up and saw the priest standing over me.

"I'm Father Rodriguez," he introduced himself with a smile, extending
his hand. I absently shook it, and his firm grip vouched that the
physical strength suggested by his robust, fit appearance was
authentic. The lines about his eyes suggested he was in his forties.

"Can I be of any help?" he asked.

I started to feel embarrassed.

"No, I'm all right, thanks--" "I coverER here. They told me all about
you downstairs.

And you can't really be 'all right," given what you've been through."

"Well,no--" "I know Jack, by the way. We used to do a bang-up lecture
together about grief counseling in Emergency at conferences out here.
He's a good man, and a hell of a ski buddy. I pray to God he gets out
of this safely."

This priest was starting to impress me.

"I take it you must have pretty mixed feelings about Martinez," he
stated, gesturing back to where the psychiatrist lay dying.

"You've got that right!" I declared through clenched teeth.

"Let me give you a word of advice, Dr. Garnet. Get back to doing what
you do best, and, as we ER priests say, leave the triage of souls to
God."

With that he squeezed my shoulder and strode off down the hall.

The ER people admitted me to a private room so I could follow events on
television and not disturb other patients.

Soon the networks were broadcasting images of the indicted anesthetists
being led away from their homes in the middle of the night, some
blinded by the glare of camera lights, others with raincoats over
their heads, and most still wearing pajamas.

Funereal-sounding reporters gave the obvious commentary.

"... an indictment of the entire company..."

"... the downfall ofBrama..."

"... vindicates the PDL..."

Within hours Jack's soldiers began releasing their hostages and
surrendering.

But there was no further word on Jack.

"... Mexican police continue to keep reporters from both sides of the
border away from the scene..."

"... local storms make it impossible to fly over the clinic..."

"... two pilots working for Brama who are grounded by the poor weather
on a landing strip near the facility reported by radio seeing an orange
glow in the sky in the direction of the building, but then radio
contact with them was lost..."

"Son of a bitch!" I screamed, driven to distraction by the infuriating
snippets that suggested the worst yet confirmed nothing. Unable to
sleep, I started to pace, pushing my IV pole as I went and desperately
wanting to talk with Janet.

I'd already made innumerable attempts to reach her again, but as luck
would have it, she'd been called into the OR on an emergency.

I must have been well into my second mile when a windswept reporter
huddled in rain gear appeared on the TV screen. Though behind her
nothing was visible except the black of night, I could tell by a
familiar low rumbling in the background that finally someone was
broadcasting live from La Rumorosa. One look at her shaken appearance
and I knew the news was bad.

"... we've just learned that there has been a tragic end to the
remarkable PDL-Brama saga. I'm reporting from the site of the clinic
where charismatic PDL leader Dr. Jack MacGregor had been holding
hostage Mr. William Baines, the company's now disgraced president.
Mexican authorities have only just confirmed that much earlier
tonight, around six-thirty p.m., Pacific time, local police from the
village of La Rumorosa, along with military advisors based at a nearby
army post outside Mexicali, launched a bungled raid on the facility in
an attempt to free Baines. Apparently, incendiary grenades were used,
and some landed in a part of the building still under construction.
Exposed wooden frames caught fire, and the flames quickly spread to a
nearby storage area where the clinic's own security forces had stored
their ammunition. According to officials, when bullets started
exploding, the Mexican police and soldiers mistakenly thought they were
being shot at and returned fire. Nine people are dead, including
Baines--who, ironically, a few hours later would have been charged with
conspiracy to commit murder--and the charismatic Dr. Jack MacGregor,
who is now being credited with uncovering the scandal at the HMO giant.
Mexican officials claim that the local officers were paying little
attention to the developing story in the U.S." and reacted as they
would with any terrorist threat. When their ultimatum to surrender was
ignored..."

The screen was suddenly filled with a shaky, slow-tracking shot along a
row of bodies that had been laid out side by side.

The harsh white lighting made the images appear black and white. Though
some of the dead had cloths covering their heads, one corpse had a long
flowing coat spread out over him.

Showing the image of his remains, the television became his coffin. By
it, I sat down and wept.

"This flight will be a lot smoother. Dr. Garnet," the pilot called
over his shoulder as he leveled off, pointing the plane away from the
sunset and toward the gathering darkness in the east.

"If you need anything, there are sandwiches and juices in the galley
fridge," the copilot added, gesturing to what amounted to a hot plate
and a cooler stashed below a countertop.

"We should be in Buffalo by one in the morning, their time."
The two men had phoned me in the morning and offered to fly me home.
They had a pickup in Boston, but could drop me off on the way there.
I'd jumped at the chance, wanting nothing more than to get to Janet and
Brendan.

"Nothing for me right now, thanks," I answered, and settled back in my
seat, eyes closed, only to become lost in my thoughts.

When the news of Jack's death broke while I was in the hospital, it had
been another half hour before Janet could extricate herself from the OR
and reach me. By then I was numb and practically monosyllabic, but
she'd patiently coaxed me to talk, and bit by bit I'd told her
everything that happened at La Rumorosa. When I tried to describe how
Jack had rescued me, I broke down again.

"I'm so sorry, Earl," she'd consoled me over and over, until I'd been
able to pull myself together and continue with the story.

"Look, get up and go down toER," she'd gently ordered when I
finished.

"Be with people who knew him. As their chief told you, you've got
friends down there now as well."

She'd been right. Even though work in the department had to go on as
usual, the staff sadly welcomed me to park my IV at the nursing station
and have some coffee. And busy as they'd been, conversations would
gravitate to me about Jack, until I came to realize the extent of my
old friend's influence there.

A resident who'd rotated through Jack's former hospital in San
Francisco gushed about his greatness as a teacher. The doctor on duty
who'd known him through ERassociations in California spoke of his
leadership. Even Father Rodriguez had shown up, seeking solace as well
as giving it over the loss of a friend.

"Here, Dr. Garnet," the copilot said now.

I gave a start, breaking off my reverie and opening my eyes to see that
he'd left his seat to hand me a blanket and pillow.
"And if you need to phone anyone," he added, "we can patch the call
through our radio."

I smiled.

"My wife knows I'm coming, and frankly, I don't want to talk with
anyone else. But hey, you guys run a great airline." I positioned the
pillow, spread the blanket over me, and once more began picking through
the day's events.

The previous afternoon, to my surprise, I'd received a call from
Riley.

"I got the number from Janet," he'd explained.

"I

wanted to say how sorry I am for your friend's death." His voice
sounded quietly sincere.

"Thanks," had been all I replied. My sharing stories and talking about
Jack in Emergency had comforted me, because it was a fitting wake among
friends and colleagues. The detective, on the other hand, sympathetic
as he sounded, was an outsider, and not someone to whom I'd show my
grief. I also had to resist snapping at him that if he'd stood up to
the FBI and persuaded them to raid the clinic a week ago, maybe Jack
would still be alive.

The subsequent pause between us lengthened enough that I had time to
wonder whether Riley was going to complain about my going to La
Rumorosa behind his back, when he suddenly demanded, "Doc, did he give
you any idea before he died if one of his people might have killed
Saswald or Forbes? Fosse's got a bug up his ass that it must have been
a rogue member of the PDL after all, and the brass have me under huge
pressure to solve this thing, no matter what. I don't have many other
ideas, and was hoping maybe you'd turned up a new lead."

Always the plodding detective, I'd thought, once more resigning myself
to the fact that he was the man he was, shortcomings and all. I'd then
proceeded to relate yet again an account of what had happened at La
Rumorosa, including Baines's claim that the killer was blackmailing
him, and Jack's denial that the killings in Buffalo had anything to do
with the PDL. Although the detective had pestered me for details of
Baines's and Jack's exact words, my not having slept all night made
accuracy a hit and miss affair.

"And after all this, you still have no idea who it could be?"

he 'd finally asked, sounding weary.

I'd decided then to reveal the suspicion I had kept to myself long
enough.

"Look, I hate to say this, but maybe you should check out Alien
Pearson's whereabouts on the nights of the killings--" "He was on duty
at the base, both times," Riley had brusquely interrupted.

"His alibi's ironclad. I checked out that possibility right after our
session with him last week."

"Oh," I replied, taken aback. After a second of feeling relieved for
the young man, I realized that we were as much at a loss for a suspect
as we'd been at the beginning of the investigation.

"Dr. Garnet," the pilot called out, snapping me back to the present
again.

"What's been really bugging me is that I can't figure why the hell Jack
didn't just surrender once we had you and that psychiatrist off the
ground. Why, for Christ's sake, did he hold out like that?"

There was pain in the man's voice. As there had been in Father
Rodriguez's when he asked me the same question back in San Diego and
his eyes had filled with a very secular torment.

I repeated what I'd told the priest.

"Because he didn't know yet if Martinez would survive, or if he did,
whether he'd make a statement strong enough to indict Baines for
murder; One way or the other. Jack was determined that the president
would get the justice he deserved." It was a simplistic explanation
that glossed over the agony of a complex man who'd been driven to
obsession. But I wanted to keep private that aspect of what Jack had
done, lest someone use it to give him a diagnosis and attribute his
acts to a pathology of character rather than courage, thereby lessening
him.

A solemn quiet broke out between me and the two men as they seemed to
mull over what I'd said. I began to suspect that their generous
hospitality was a prelude to getting me to talk about Jack, and that
in time they'd want to ask more questions, or tell the stories of their
own friendship with him. That was fine with me.

I spent the next minutes gazing down at the snowy ridges of the coastal
mountains that separated California from the rest of the country. The
low sun cast the western slopes in gold and the eastern sides in a
blue-green shadow. But I found myself looking south, toward where the
sinewy landscape of La Rumorosa lay. I didn't believe in ghosts, but
if ever there was a place for an angry spirit to roam, I wouldn't be
surprised if the locals started to report sightings of a tall figure
striding through the clinic ruins, a long coat flowing out behind
him.

Rainy days and frosty nights had left Buffalo coated with ice and
glittering like a rhinestone cowboy. But the bite in the air along
with the added chill of freshwater dampness blowing off Lake Erie were
familiar discomforts, and I felt welcomed by them as I walked through
the deserted parking lot at the airport. It took a few yanks to get my
car door open, the earlier storms having frozen even the locks.

Driving was equally tricky. I'd intended to pick up a further supply
of antibiotics to continue medicating myself at home and was heading
for the hospital, but it was slow going. I also managed to get myself
worked up about a solitary pair of headlights that seemed to be
following me, staying a steady few blocks behind. Since there were
virtually no other vehicles on the road, whoever it was remained easy
to keep track of. In the end, however, it proved to be a false alarm
as the car turned and headed up a side street when I got to within a
block of St. Paul's.

"Hey! It's the famous Dr. Garnet!" the receptionist exclaimed as
soon as I walked into Emergency.

"Welcome back!" the triage nurse declared.

"When I saw you on CNN, I couldn't believe my eyes."
"They could have killed you along with those other poor men!" another
added.

By then half a dozen people had dropped what they'd been doing,
gathering around to inquire if I was okay while patting me on the back
and giving me hugs.

"And what's this about pneumonia?" the charge nurse asked.

"How'd you know about that?" I demanded, somewhat surprised.

"Janet phoned and warned us you'd be dropping by to pick up the
clindamycin and cefotaxime you'd be needing." She gestured to a
medium-sized box on the counter.

"We got it ready for you, plus the IV equipment to inject it with."

"Why, thanks," I said, stepping over to pick it up.

"I'll be back to work in about a week--" "Not so fast," she
interrupted, reaching for the phone and punching in just four
numbers.

"Unfortunately, Mr. Fosse also found out you'd be coming in, and left
strict orders that you were to see him immediately."

"Now? It's nearly two a.m."

"I know, but orders are orders."

"Forget it! I'm too tired!"

"Mr. Fosse," she exclaimed into the receiver, ignoring me.

"He's here. We're sending him up."

I grabbed the receiver from her and started to tell him, "No way--" but
he'd hung up. When I dialed the extension back, the line was busy.

"Christ," I complained to the nurse, "you could have given me a break
and simply not called him." I had half a mind to ignore the summons
anyway and head home.

She winced at the rebuke.

"I'm sorry. Dr. Garnet," she said remorsefully, "but I have to do
what he says, because he is the big boss."

"As are all CEOs everywhere," I muttered, equally as mystified as I was
resentful at his insistence on seeing me.

"Ah, what the hell," I said, then turned and strode toward the
elevators. Walking up a staircase, I'd discovered earlier back in San
Diego, was enough to leave me wheezing and coughing.

Fosse's eyes were dark with fatigue, and he appeared strained when he
greeted me at his office door.

"Come in, and thank God you're safe!" he exclaimed, gripping me by the
shoulders.

"I apologize for hauling you up here, but I waited up after I found out
from Janet that you were flying in tonight.

She told me you'd be stopping by to pick up your medication.

How are you feeling, by the way, besides tired? She said you had
pneumonia." He was speaking rapidly, the way people often do when
they're nervous, and the pitch of his voice was a notch higher than
usual. Whatever he was worked up about, it was unusual for him to let
his stress extend even to his vocal cords.

"Physically I'm a wreck, but of course my pneumonia will get better, in
about a week," I replied.

"And yes, I'm tired, in fact exhausted is more the word I'd use. As
for how I am mentally, given what happened to Jack, I quite frankly am
not in good shape at all."

He looked taken aback at my curt greeting.

"Of course. Dr.

Garnet. I'm sorry to have spoken so stupidly," he quickly countered.

I hadn't intended to be quite so blunt, but had meant every word and
figured it was the best way to make sure he knew to keep whatever he
had in mind mercifully short. His addressing me formally, however,
warned that I'd stung him harder than I should have.

"How else would you be feeling but devastated," he went on.

"Please excuse my lapse of sensitivity."

I said nothing, there being nothing to say.

"And what a stupid, unnecessary tragedy," he. added, starting to sound
awkward. Get to the point, I was about to tell him, when he continued,
"But it's his death that made it urgent I speak with you tonight. I'm
afraid it may have placed you in very grave danger."

"Me?" I exclaimed, taken aback.

"But why?"
"Here, sit down. I've made tea." He gestured to one of his many
chairs. A tray with cups and a steaming, sterling silver pot sat on a
nearby end table.

Without thinking about it, I chose the love seat, sitting well forward
on its edge.

"I've already expressed my fears to Detective Riley," he continued,
"and suggested that you receive official protection again, resuming
tomorrow. He agreed--" "Protection from whom?" I demanded, refusing
to endure any more of his beating around the bush.

"From the person who killed Saswald and Forbes."

"What?"

"Because if the killer is a rogue member of the PDL, then who knows how
he'll react to his leader's death? My worry is he might blame you for
leaving MacGregor there."

"But Jack said he'd investigated his own people and didn't think they
had anything to do with those deaths--Wait a minute! What are you
insinuating? That I abandoned Jack?" I felt as if he'd slugged me.
I'd been swept by a wash of emotions since Jack's death--grief,
despair, shame at my own terror--but mercifully, I'd been spared guilt,
at least so far. I certainly was in no condition now to even hear the
suggestion that I'd run out on him.

"Oh, my God, Earl, of course not!" Fosse immediately protested.

"Don't for a minute think that I or anyone who's sane would even
consider that you're in any way responsible for how things turned out
down there. I'm referring to how some unhinged maniac in the PDL might
react."

But his belated reassurance that I wasn't at fault did little good. My
doubts, once unleashed, seemed limitless. Should I have refused to
leave La Rumorosa? Rushed out and met the police myself? Insisted
more forcefully that Jack go with us?

"I told you. Jack assured me that he'd checked out his own ranks," I
asserted almost absently.

"He was convinced there was some other game afoot." This time,
invoking his exact words, it hit me that I'd never hear his voice
again. Already profoundly rattled, I felt tears welling up in my eyes
and had to fight them back.

"Don't you think he could have been mistaken?" Fosse pressed, speaking
quietly as he poured and then handed me a cup of tea.

I cradled the warm drink between my palms.

"He seemed pretty sure, and it's not like he'd have needed to check out
his whole organization coast to coast. From what Baines told me, the
killer always called him from Buffalo, which makes it likely he was a
local."

"Ah yes, the blackmail. Riley told me all about that. It's quite a
story."

I took a long sip of the warm amber fluid and felt its heat travel all
the way into my stomach.

"It surprised the hell out of me!" I said, taking a second mouthful
and still trying to get a grip on my emotions. Fosse wasn't usually so
clumsy when it came to not saying the wrong thing, but I doubted he
could have gotten me more shaken up if he'd tried. I was finding it
hard to concentrate.

"But why couldn't that blackmailer be from the PDL?" he continued to
insist.

"MacGregor still might easily have been wrong about one of his people
here, even though there weren't a lot of them."

"Because there were other things about this killer that Baines let
slip. Things that point elsewhere than the PDL, such as the way the
blackmailer timed his harassment of Baines and the demands for more
money."

"What do you mean?" Fosse asked. He hadn't served himself anything or
sat down, and was slowly pacing in front of his photo gallery of
pictures. The image of his younger self in his military uniform peered
down at him.

"How did Baines put it?

"Whenever the police were pressing particularly hard, he demanded
more," I think were his words. My head wasn't too clear at the
time."

"And you think that's significant?"
My mind was almost too drained to keep track of my own logic.

"I don't know. I'm probably making a lot out of nothing, but it
suggests that the blackmailer knew exactly what the police were doing
and when they were doing it with regard to their putting pressure on
Baines and Brama, and could time his extortion attempts accordingly.
That's also consistent with his knowing that Riley was about to arrest
Forbes and then getting to the psychiatrist just minutes before us.

Jack, on the other hand, made it clear the PDL didn't have a good line
on what the police were up to--that's why he grabbed me for
questioning. No, I think it's a person outside the PDL and that Jack
was right about there being something else going on that we don't know
about."

He looked disappointed that I'd shot down his idea.

"Yes, I suppose you're right," he said softly.

"I take it you've informed Riley about what Baines said."

"Not about the timing of the blackmail attempts. I'll tell him that
tomorrow."

"I see," Fosse said, remaining motionless.

I looked up at him, and was again taken by how hollow eyed he looked as
he stared at me.

"Christ, you need sleep as much as I do," I exclaimed, getting to my
feet as my legs threatened to go into spasm again after being
immobile.

"And I'm so racked I can't add two plus two right now, let alone put
together all these bits and pieces--" "Of course, Earl!" he exclaimed,
immediately apologetic again, and he gave me his best grandfatherly
smile.

"I'm sorry I hauled you in here, but I just had to make sure you
understood my concerns and took them seriously enough to be careful.
Hell, Detective Riley certainly assured me that he thinks it's
important. He offered to cancel some annual hunting trip that he takes
his men on this time of year, in order to personally supervise the
operation of keeping you safe. So, despite your skepticism about the
killer being from the PDL, promise me you'll accept the protection."
Oh Jesus, I sighed, quickly resigned to the fact that I was going to
be mother-henned by the police as well as Fosse for the next few
days.

"Okay, I'll be careful," I promised.

But my acquiescing failed to lessen his worried expression.

In fact he seemed to grow more uneasy, repeatedly swallowing and
pursing his lips as if he was reluctant to say something.

"Will you indulge an old man a few more minutes?"

he finally asked.

"Sure," I replied as pleasantly as I could, thinking only of falling
asleep in Janet's arms.

"Because I've just had a brain wave, except I'm hesitant about
confiding it to you, it's such a strange idea."

I waited for him to elaborate, but he continued to look indecisive
about saying anything more.

"Try me," I told him, attempting to hide my impatience with his keeping
me here.

He took a breath, as if bracing himself.

"Earl, once your own protection is assured, I want you to consider that
it might be better if this killer is never caught."

"What!"

"I know it sounds crazy," he hastily added, motioning me to stay calm
with his outstretched palms, "but I don't share everybody's optimism
that Brama's collapse will make the other HMOs pull in their horns and
behave, at least not in the long run. Hell, I'm so sure of it that
I've decided to postpone my retirement awhile in order to be here when
they start messing with St. Paul's again."

"You're staying on? Why, that's great. But I don't see how you can
even suggest leaving a dangerous maniac--" "Consider how much more
effective our using the Robert Delany fund and threatening bad
publicity would be," he interrupted, "if the CEOs thought this killer
was still on the loose and might pay them a visit if they got out of
line."

"You can't be serious."

"I'm not suggesting you do anything wrong. Just that you let the idea
of him being out there work to our advantage.

It would be like having a knife to the throat of the HMO industry--so
to speak. And it would work. Remember how Brama started backing off
our patients just before you went to Mexico? Baines fearing that he
was about to get his throat slashed probably had a lot more to do with
it than you and I screaming at him through the media."

"I know, but--" "Something both my grandfather and Special Forces in
Vietnam taught me was that the enemy of my enemy can be useful in a
fight. Think about that before you talk to Riley."

"What do you mean?"

"I'm suggesting that you don't help the detective too much in tracking
down this killer. If you do, you'll be working against our best
long-term strategy to keep HMOs accountable for a very long time."

"Jesus, Reginald, that's the screwiest thinking I've ever heard you
come up with. Your brain must be as fried as mine from lack of sleep."
My real reaction was a lot less kind. He was starting to sound as
extreme as Jack had been, I thought, but then put what he'd said down
to a momentary lapse from all the stress he'd been under the last few
weeks.

"By mo ming we'll both be making a lot more sense, and we can each
offer our ideas to the police," I added, suddenly feeling embarrassed
for the old guy and wanting to afford him some room to back off his
loony proposal yet keep his dignity.

He started to protest, then fell silent.

"Yes, I suppose you're right," he said quietly after a few seconds,
appearing resigned to let the matter drop, but once more he looked
disappointed that I hadn't agreed with him. He then drew back his
shoulders, pulled himself erect, and reassumed his usual take-charge
bearing.

"Of course it was a silly idea," he said briskly, "born out of fatigue,
frustration, and my fear of losing our momentary advantage over managed
care. Please forgive me."

"Don't worry about it," I said with a smile.

"We all get a little weird when we're short on rest."
"Now you go home and stay in bed until you're better" he ordered,
placing his arm around my shoulder.

"Oh, damn!"

he suddenly exclaimed.

"I forgot. It's budget week!"

I groaned at the sudden reminder that I still had a department to run.
In particular, preparing the annual statement of accounts for ER was
probably my most tedious task as chief.

"Tell you what," he continued.

"Before you leave, if you'll take a minute and transfer the file to my
computer, I'll take care of the report for you myself. Then you can
convalesce without a thing to worry about," he added, smiling broadly
again.

I would have welcomed the offer even if I'd been in the best of
health.

"Why, thank you, that's most thoughtful--" "Not at all," he said
jovially, seeing me to the door and shaking my hand with the warmth of
a perfect host.

"Now home with you, to the care of the lovely Janet!"

Fosse had meant well with his warnings, I guess, but the entire meeting
left me feeling on edge and strained. I had to admit, however, that if
Jack had been wrong, and there was a maniac in the local chapter of the
PDL, what Fosse said about me being a possible target made a certain
amount of sense.

And once I was alone in the parking lot, despite my initial skepticism,
the idea had me edgy and imagining things.

Clutching my box of supplies against my chest, I hurried along, jumping
at shadows and listening as the wind moaned overhead between the
building tops. Down at ground level it gusted in fits and starts,
sending the litter scurrying about like marauding rodents.

It had taken a lot more than a minute to locate and transfer my budget
files to Fosse's computer, but given the hours of work he'd save me, I
didn't mind taking the trouble, despite being so sleepy. What I wished
I hadn't done was see the stacks of mail and files on my desk that were
waiting to be dealt with.

The dark recesses between the Dumpsters where Riley's men had ambushed
me lay ahead. I figured it would take little more than a rat jumping
out at my feet to send me screaming through the night again, and I gave
the area a wide berth.

Crossing the place where Saswald had been butchered proved no less
taxing. I kept looking over my left shoulder, back toward the
Dumpsters, expecting to see his killer descending on me, but no one was
there. I shivered and quickened my pace, heading for the better-lit
doctors' parking area.

But surveying the deserted expanse beyond left me remembering the night
when Jack's men had come up on me as I'd gotten into my car, and I took
an uneasy glance behind me to my right.

He was little more than a moving smudge in the darkness, following my
progress from well inside the abandoned lot adjacent to the hospital.
If it hadn't have been for the motion of his rain gear billowing in the
wind I might never have noticed him. Instinctively I froze, gaping at
him, making sure I hadn't conjured up yet another bogeyman, but that
pause was enough to start him striding directly toward me like a
shrouded angel on black wings, his hooded poncho floating out behind
him.

"Jesus Christ!" I yelled, dropping the box, and pivoted, sprinting for
my car. After ten steps I could barely breathe.

"Help!" I screamed, but at that hour there was no one to hear.

I glanced back and saw a long glint from the blade he was carrying as
he passed through a pool of light under an overhead sodium lamp. He
started to run. On his outfit, distinctive khaki and brown markings of
military camouflage stood out in the orange illumination before he
passed into the shadows again.

Oh, my God! I thought. Riley had been wrong, and it was Alien after
all!

I continued my feeble attempt at speed, fumbling in my pocket for my
keys as I ran. I got them out though the vehicle was still a dozen
rows away. But I'd covered barely half that distance when my airway
clamped itself into a paroxysm of coughing, making it impossible for me
to breathe. Stumbling, I made it another ten feet before sinking to my
hands and knees, fighting for air and continuing to choke. No sooner
did I turn for another look at my attacker than he was on me and yanked
my head back by the hair. My neck exposed, he drew his blade up in the
air where it remained poised, ready for the killing stroke. My palms
instinctively flew up to ward it off, and deep within the recesses of
his hood I saw my killer's face.

"You!" I exclaimed, the shock equal to my terror.

Then from the darkness behind him came a booming gunshot, and his
features disappeared into an explosion of tissue and blood. What was
left of his head snapped forward, spilling its contents onto the
pavement in front of me while the rest of his body slumped over on top
of mine.

Riley came running up carrying a rifle just as I was getting out from
under the still-twitching corpse.

"Jesus, Doc, that was close. I was parked in the shadows on the
street--too far away for using a pistol--but I had my own bear gun in
the trunk of my car. Who is it?"

I was so shaken I couldn't speak, and unsteadily got to my feet. My
hands, my clothes, my shoes--everything was already drenched in blood,
and the asphalt around us continued to turn red.

Riley tiptoed through the mess and stooped down by the body. The hood
of the army poncho was stuck to the back of the head, embedded in the
hole where the bullet had gone in.

But Riley was able to lift and peel back enough of the front opening to
see what remained underneath. The face was gone, turned into a
dripping pulp. But the temples and the jaw were there, and so were the
thinning white hairline and bristly full beard of Reginald Fosse.
Chapter 24

Why had Fosse done it?

The question began hammering at me even as we stood by his body,
listening to the approaching police sirens.

A mobster running a protection racket, Baines had said of the
blackmailer. Let me introduce you to my teacher. Fosse had said when
he'd shown me the faded picture of his grandfather. Hit the leader
hard... send a very clear message... and you have no more trouble, the
old gangster had once told him.

But as my mind tossed up fragments from the events of the last few
weeks, reflexively attempting to provide the pieces that might fit
together and give me an answer, I glanced at Riley, thinking to ask,
"How did you know to be here?"

He gave a sardonic laugh.

"Believe it or not, it was Fosse's insisting that you might be in
danger" "Fosse?"

"Yeah. After I talked with you, he was still on me with that idea of
his about a rogue PDL member--making it seem a very credible threat, I
might add--except he kept repeating that my providing protection for
you should start first thing in the morning. Why not tonight? I
thought to myself after he'd hung up. I can't say I was suspicious of
him then, but I kept thinking about how this killer had beaten us to
the punch with Forbes, and I headed for the airport, just in case."

Three squad cars flashing red and blue came screaming into the lot.

"But as I waited for you to arrive," Riley continued, "I kept 562
mulling over the timing of that murder, and ended up second guessing
why I hadn't made anything of the fact that he'd been the only person
outside of my men whom we'd told that Forbes's arrest was imminent. Of
course our initial suspicions ofBaines being the killer had overridden
our thinking that night, but in retrospect, not to have at least
entertained some suspicions about Fosse and questioned him at that
point seemed pretty indefensible. And as I thought some more, I
realized that the main reason I'd been so lax toward Fosse was because
he'd made it seem as if he was one of us--on my side of the badge, so
to speak--by having been so damned helpful-exactly the way he'd seemed
today."

The vehicles screeched to a halt around us and a halfdozen car doors
flew open, each one disgorging a uniformed officer.

"So rather than be lulled again into missing something by all that
helpfulness of his, I took a critical look at the man with my cop's
instincts turned on full, and that's when I had my first sliver of
suspicion about him." Holding his police ID up to his onrushing
colleagues, he added, "What if he pushed for a morning start because he
didn't want me near you tonight?"

Riley stepped away and quickly briefed the men on what had happened.
One of them immediately got on the radio, calling for more cops, and
from the comments I overheard, they seemed more concerned about the
detective's use of an "unauthorized weapon" to bring down a "suspect"
than the fact I'd been about to have my throat cut.

Riley turned back to me.

"Once I'd entertained the possibility that he was a threat, what leaped
out at me was the extent he'd influenced our thoughts and actions
during the investigation. I specifically remembered the way, after
Forbes had been killed. Fosse's useful insights on alcoholism and
research had nudged you toward a pretty accurate hypothesis about what
was going on at the clinic. Had he already known?
I wondered. When I put that possibility together with your telling me
today that the killer had been blackmailing Baines, I came up with
another suspicion. Could Fosse have been priming us to put more
pressure on Baines?"

An additional six police cars were entering the lot, lights flashing
but without sirens. Behind them came a pair of mobile units from
competing TV stations. The officers who'd already arrived had begun
erecting a perimeter of yellow tape around where Fosse lay, the large
hunting knife still at his side. Riley again broke off talking with
me, this time long enough to hand his rifle to one of them.

"Tag this for the shooting review, then lock it in the trunk of your
car," he ordered curtly.

"I'm going to get enough flak without the media getting a picture of me
standing over the body with it.

"Cop Bags CEO with Bear Gun' isn't what I want to see in the mo ming
news."

As he took care of business I started to cough, and realized I was
shivering. Whether from cold, pneumonia, or a latent reaction to what
had just happened, I couldn't tell.

"Jesus, Doc, you need a hot coffee," Riley said, taking me by the elbow
when he returned.

"I've got a second thermos in my car that I haven't even opened yet.
Besides, it's going to be a circus around here."

The steaming, turbid liquid was so strong that it left a grit on my
teeth.

"Stakeout strength," Riley had called it, but between its warming my
insides and the heater working on me from without, in minutes I'd
stopped shaking.

As we sat there the detective continued to elaborate about the art of
blackmail.

"It always involves tormenting the mark with possible exposure to make
him or her pay up. So I wondered if Fosse had been laying the
groundwork for you to threaten the hell out of Baines with a bang-on
accusation about the clinic. If you remember, Fosse also had already
set up our meeting with Baines at the Brama building, and it
coincidentally fell on the morning after Forbes was murdered. It even
crossed my mind that maybe he'd been the one who threatened you and
Janet over the phone a few days earlier, creating the pretext he'd
need to invite me along when the opportune time to pay Baines a visit
arrived."

"Oh my God!" I exclaimed, making a connection that had evaded me until
then.

"Baines's description of his blackmailer's voice being 'husky,
disguised," described exactly what the caller who'd menaced me sounded
like. But that would mean Fosse had it all planned ahead, including
his killing Forbes." A greedy con man on the take ... a sadist, a
murderer, a blackmailer, an exploiter .. . Baines's words--everything
he'd mistakenly accused Jack of--now echoed in my head about Fosse. Yet
my instincts rebelled. There had to be more to the man and what he'd
done than that.

"His campaign to terrorize Baines wasn't the only thing, I figured,
which he thought out beforehand," Riley added.

"Remember the timely way he pulled out that 'mother hen' book of his,
and used it the next day to establish a link between Saswald and David
Pearson at the clinic? Once again I think he was setting the stage for
me to bring more grief to Baines.

Not that he wasn't capable of also taking full advantage of
opportunities which came to him by chance. When you offered to
infiltrate the clinic, he must have jumped to help you, probably
calculating that you'd expose the aversion therapy, but not the
murders, leaving Baines more vulnerable than ever to blackmail, but
Brama itself still in business, at least enough to continue providing
him with a cash flow. MacGregor launching his campaign a week early
probably caught Fosse off guard as much as it did the rest of us."

Whatever Riley felt or thought about my subterfuge in going to Mexico,
he once more gave no sign of it. Given that I now owed the man my
life, I dreaded his asking why I hadn't confided in him, and welcomed
his apparent willingness to let the matter be.

"But how did Fosse find out that Saswald had killed David Pearson in
the first place?" I asked.

He flashed me a sly grin over the top of his mug.
"Remember the fight his secretary said that he had in his office with
Saswald, the Wednesday prior to the anesthetist being killed?"

"Yeah. Fosse claimed that it had been over the short notice Saswald
had given him before quitting."

"Well, if you combine that with what Alien Pearson told us, that's the
same day the young Marine said he first approached Fosse, to request
his help with getting more information about what had happened to his
father. Now here I have to speculate, but Fosse, knowing that Saswald
regularly worked at Brama's freestanding clinics, may in all innocence
have summoned the anesthetist to ask him if he knew about the addiction
center and to request his help in finding news about David Pearson.
Saswald, freshly returned from the session which had resulted in the
death of Pearson, probably freaked. Fosse's secretary said he'd
arrived for the meeting already looking stressed--I guess he could have
lived with killing patients from other hospitals in distant cities, but
having lost one from his own turf, he was probably feeling extremely
vulnerable. Who knows. Fosse may have picked up from his reactions
that he was hiding something, and bullied the truth out of him. All we
know for sure is that when the meeting finished, Saswald had resigned
from St. Paul's. Whether at Fosse's insistence or Saswald's, it would
make sense from the anesthetist's point of view to keep as far away
from the hospital as possible, what with Alien Pearson starting to
demand answers."

I downed the remaining swallow of my coffee and chewed on its dregs.

"It all sounds pretty convincing."

"It was enough for me to think it could be him. By the time you
landed, I'd also decided that Fosse's rogue-member-of the-PDL story
might not only be a crock, but could be his latest attempt to create a
scapegoat, this one imaginary, for the murders of Saswald and Forbes.
You know that from the beginning the bastard wrote that message,
"Pearson ... too young," intending not only to make Baines sweat, but
also to ultimately make us suspect Alien Pearson."
I nodded, recalling how Fosse had cleverly led me to that conclusion
as well, dropping the photo of David and Alien and casually
recapitulating the phrase when he'd said, Boy, they could be twins,
except of course the son is too young.

"But what really got my heart pounding was when I realized that his
touting the PDL notion could also be his seeding an explanation for
your murder. Needless to say, I couldn't prove any of it, but when I
realized you were heading here, I made sure I found a vantage point
from where I could see your parking spot, the entrance to Emergency,
and the ground in between."

I shivered, despite the heat in the car, and sat in silence. As Riley
refreshed our cups a light rain began to patter on the roof and streak
the windshield.

"It troubles me why a man like Fosse would resort to murder and
blackmail," I finally said, taking a sip of the steaming, dark fluid.
It tasted even sludgier than before, but the heat was marvelous.

"And perhaps it's my vanity speaking, but I find it particularly
galling how he could have brought himself to try and murder me!" I
exclaimed loudly, getting over my shock enough to feel the beginning of
outrage at his treachery.

Riley heaved one of his huge sighs.

"Why people kill is always a grim business, Doc. But in this case, I
think we've got a number of reasons. Because once Fosse found out
about David Pearson's murder, he must have realized that he had Baines
and Brama, along with its billions, at his mercy. Now, he hated what
the company stood for anyway, and in my business, money is also always
a pretty good motive. As for Saswald and Forbes, he probably loathed
them for the part they'd played in Pearson's death..."

As he talked I found myself once more rebelling against the detective's
version of what had driven Fosse to kill. Drawn in too broad strokes
and partly predicated on greed, it struck me as crude and incomplete,
the way a police composite often is. And I remained particularly
convinced that there had to be a reason other than money behind his
attempt to take my life. So while Riley continued to focus on the
man's deceit, I tried to construct a fuller picture of Fosse; hoping
for a more accurate explanation by including the times when he'd let
the truth of his passion show through. Images floated to my' mind: his
screaming in outrage over Robert Delany's death;

his sending a wastepaper basket sailing over the board members' heads
in his fury at their indifference to the tragedy; his public agonizing
over Brama attacking and threatening to undo everything he'd stood for
throughout his career. I recalled the rage in Fosse's eyes as he'd
related to me the "roots" that had forged his purpose and driven him
all his life--his parents dying in misery; their deaths plunging him
and his siblings into desperate straits; the death of his own wife and
unborn child--all, in his mind, the result of arrogance and
indifference.

I remembered the photo of him with his grandfather, and I could only
imagine what lessons in ruthlessness he might have learned from the
grim-looking gangster who had helped him survive.

"It was his own fervor that did him in," I interrupted, "and the
bitterness that fed it."

"What?" Riley said, his expression curling into puzzlement.

"You're not going to give me any of that "I'm depraved on account of
I've been deprived' crap?"

I tried to explain to the increasingly skeptical detective what I
thought had twisted Fosse so that he'd been unable to resist a chance
to destroy Brama, but my attempt was brought to an abrupt end when a
sharp knock on his side of the car interrupted me.

"Sir, the lab people are here and need to know what you want done,"
said a young policewoman to Riley after he'd rolled down the window.

"Excuse me. Doc," he said, getting out.

"Stay here and keep warm. We'll need a statement in a few minutes,
then you can head home. And a word of advice: The guy's dead. We
don't need to establish a motive because there's not going to be a
trial. Neither is he worth dwelling on. As far as I'm concerned, in
the end he was after the money and was willing to kill you so as not to
get caught."

He was gone before I had a chance to protest that it couldn't be that
simple.

Janet met me at the door. Slipping into her arms and enfolding her in
mine, I surrendered to the feel other through her robe, the smell of
her hair, the tiny murmurs of relief that came from her throat. For
that exquisite moment as we stood clasping each other I was freed from
all thoughts ofSaswald, Baines, and Brama. Finally she leaned her head
back, looked at me with teary eyes, and said, "For the next week you're
mine, Brendan s, and Mufiy's, while the rest of the world can go to
hell."

Except the world intruded despite her orders.

Once she'd settled me in bed and injected me with my next dose of
antibiotics, I told her about Fosse.

Her reaction--questioning disbelief, horror, and finally anger at the
way he'd deceived us all--left her ashen and silent.

"I was so wrong about the man," she finally said in a faraway voice,
"and I was so wrong the other way about poor Jack." For a woman who
prided herself on her intuition about people, it was a shattering
admission.

"It's strange though-how they both could turn so ruthless, be so
willing to play God for the same cause, yet be so different that one
ended up a murderer, the other a martyr."

We lay in each other's arms the rest of the night, neither of us
sleeping very well, and when I did nod off, it was visions of Fosse
coming at me out of the darkness that troubled my dreams.

The phone calls from the press started at daybreak, before even Brendan
and Muffy were awake.

"Dr. Garnet, do you have any comment about the shooting ofyourCEO?"

"No"
"Do you condone groups like the PDL?"

"Not exactly, but as Dr. Jack MacGregor once said to me, Acre's a lot
of understandable anger out there."

"What are the lessons to be learned in the Brama fiasco?"

That question harped back to an answer I gave weeks ago.

After mulling it over a moment, I decided that the reply still held.

"We've got a trillion-dollar health care industry, and the peddlers who
market it can make money by giving bad advice without being held
accountable. Fix that, and we'll all be a lot farther ahead."

Then Janet and I unplugged the phones.

Muffy awoke and happily insisted I walk her. Brendan squealed with
delight at seeing me when I got him up, and I reveled in having
breakfast with him.

Afterward we all gathered in the living room. Outside, the early
morning light waxed, revealing a silver world of ice covered trees and
snow-dusted grass. Immediately Brendan wanted to go and play in it. We
got him dressed, and I found his sled in the basement where we'd stored
it at the end of last winter. Slipping all the way, I towed him around
and around the yard while Muffy pranced and happily ran even bigger
circles about our own. Janet watched from a window, hugging herself in
a robe and looking somber at first. Then her face softened, and a
glorious smile appeared when Brendan gleefully joined Muffy in panting
out great white puffs of breath in the frost.

When we came back in, Janet had made fresh coffee and clearly wanted to
talk.

"What I don't get is why Fosse chose now to revert to such extreme
measures," she started, once we were settled at the kitchen table.

"After all, he'd presumably wrestled with those forces from his past
for a lifetime without giving in to them."

"Perhaps he felt he was running out of time. Brama was winning, and he
was about to retire."
"But why, when he knew he had them dead to rights, didn't he just go
to the police? He could have put them out of business then and
there."

As usual, Janet had cut to the bone of the matter.

"Perhaps he wanted to issue suitable punishment himself," I offered.

"Certainly me state could never match what he had in mind for Saswald
and Forbes."

She shot me a dissatisfied look.

"Maybe, but that kind of blood lust alone seems a pretty crude motive
to make a man like Fosse embark on such a violent, high-risk path." She
paused, frowning as she thought in silence for a few seconds.

"However, if what he really intended was to keep the company alive but
in his grasp so he could continue to milk it for money..." She let her
voice trail off into the obvious conclusion that his actions would then
have made sense.

I said nothing, beginning to wonder if Riley had been right after all
about greed being a major part of Fosse's motives.

And I had to admit that the CEO's willingness to kill me rather than
risk getting caught was consistent with a guy determined to stay free
and spend the cash.

"But I don't see that man doing all he did just for money either," she
concluded, casting us both back to square one.

Janet went to work, but the puzzle stayed with me despite Riley's
advice to let it drop.

I even tried to put myself in Fosse's shoes at the moment he must have
realized he had Brama by the throat.

And that's when I realized what he'd done.

A single phone call confirmed everything.

"I know why Fosse did it," I blurted to Riley when I tracked him down
on his cellular.

"Doc, I told you that I don't particularly care, and you should forget
about it--" "Do you want to know where all the money is?"

That got his interest.
"You have to remember, when Fosse first made his decision to blackmail
Baines, Jack MacGregor and the PDL weren't anywhere on the scene yet.
Not only was he faced with Brama threatening everything he'd worked
for, but all the other HMOs were following suit. Just getting rid of
Brama wouldn't solve the problem. He'd have to bring them all to
heel."

"So where does the money come in?" Riley demanded impatiently.

"That's the point. He figured he could challenge the HMO industry and
take more money than he could ever raise, despite his prowess at
soliciting endowments. But suddenly he had a ten-billion-dollar-a-year
company at his mercy which he could shake down for protection
money--indefinitely--to finance his crusade."

"How the hell can you be so sure about all this?"

"Because I just got off the phone with an accountant at St.

Paul's."

"So?"

"There are exactly thirteen million dollars in the Robert Delany
Fund."

"So why do you think he tried to kill you?" Janet asked softly as we
sat side by side on the couch that night. Brendan was in bed, Muffy
was asleep at our feet, and I'd just related what I discovered about
Fosse and the money.

"It's a mind-set of crooks and soldiers," I answered, having spent most
of the day dwelling on the question, "to sacrifice one of their own if
he's a threat to the mission. The best I can say for him is that he
certainly didn't take the decision lightly.

After he found out what I knew at that trumped-up meeting of his, I'm
sure he was trying to divert me away from the truth so he wouldn't have
to kill me. But once I'd made it pretty clear that I didn't buy his
rogue-member-of-the-PDL story and that I wouldn't back off helping
Riley find the killer, he had no choice but to get rid of me. Otherwise
it was likely that I'd put the pieces together, and he'd no longer be
free to carry on with his cause. Of course, I had to die the same way
as Saswald and Forbes, in order to substantiate the story that the
killer was in the PDL after all--and that this PDL killer blamed me for
Jack's death."

"He decided to kill you so he could run the Robert Delany Fund?" Janet
cried, her eyes bulging with disbelief.

I smiled at her indignation.

"No, it had to be for more than that. I figure it was to keep 'the
knife at the throat' threat alive, to be invoked against any CEO who
needed a reminder about how to behave. Hell, if he followed his
grandfather's rules, he might have intended to dispatch one from time
to time so the others would stay in line."

"That's horrific," Janet said with a shiver.

"But effective. And who knows if someone else won't get the same idea
as Fosse, if the managed care industry starts resorting to the same old
tricks."

That prospect kept us both silent for a while, and I took comfort from
feeling Janet's head on my chest.

"Earl," she said quietly after a few minutes.

"You sounded good on the radio giving all those interviews."

"Thanks."

A few more minutes went by.

"Have you ever thought of doing what David Pearson did?"

"A radio program?"

"Sure, except you could use it as a forum."

"To do what?"

"To start organizing physicians in this town, while the HMOs are still
smarting, and making sure that the doctors stay in control this time,
at least around here."

It was something worth thinking about.