In an adjacent prep room, he stripped to his undershorts, stepped into a pair of disposable slippers, and wrapped himself in a thin, pale-green, collarless robe with short sleeves.

Back in the diagnostics laboratory, Dr. Gupta had arrived, as had the radiologist.

The examination table was more comfortable than Ryan expected. Samar Gupta explained that comfort was necessary because during this procedure, a patient must lie on his back, very still, for at least an hour, in some cases perhaps for two hours or more.

Suspended over the table, a fluoroscope would instantly project moving x-ray images on a fluorescent screen.

As the cardiologist, assisted by Nurse Whipset, prepared for the procedure, Ismay Clemm monitored Ryan’s pulse. “You’re doing fine, child.”

The sedative began to take effect, and he felt calmer, although wide awake.

Kyra Whipset scrubbed Ryan’s neck and painted a portion of it with iodine.

After applying a topical anesthetic to steal the sting from the needle, Dr. Gupta administered a local anesthetic by injection to the same area.

Soon Ryan could feel nothing when the physician tested the nerve response in his neck.

He closed his eyes while something with an astringent smell was swabbed on his numb flesh.

Describing his actions aloud, Dr. Gupta made a small incision in Ryan’s jugular vein and introduced a thin, highly flexible catheter.

Ryan opened his eyes and watched the fluoroscope as it followed the tedious progress of the catheter, which the cardiologist threaded carefully into his heart, guided by the image on the screen.

He wondered what would happen if in the midst of this procedure he suffered a seizure as he had on the surfboard, his heart abruptly hammering two or three hundred beats a minute. He decided not to ask.

“How are you doing?” Dr. Gupta inquired.

“Fine. I don’t feel anything.”

“Just relax. We’re making excellent progress.”

Ryan realized that Ismay Clemm was quietly reporting on his heart rhythm, which evidently had become slightly unstable upon the introduction of the catheter.

Maybe this was normal, maybe not, but the instability passed.

And the beat goes on.

Once the primary catheter was in place, Dr. Gupta inserted into it a second catheter, a bioptome, with tiny jaws at its tip.

Ryan had lost all sense of time. He might have been on the table a few minutes or an hour.

His legs ached. In spite of the sedative, the muscles in his calves were tense. His right hand had tightened into a fist; he opened it, as if hoping to receive another’s hand, a gift.

Long he lay there, wondering, fearing.

The jaws of the bioptome bit.

Inhaling with a hiss through clenched teeth, Ryan didn’t think that he imagined the quick painful pinch, but perhaps he was reacting to the brief frantic stutter of his heart on the fluorescent screen.

Dr. Gupta retrieved the first sample of Ryan’s cardiac muscle.

Nurse Clemm said, “Don’t hold your breath, honey.”

Exhaling, Ryan realized that he expected to die during the procedure.

TEN

In just seventy minutes the biopsy had been completed and the incision repaired with stitches.

The power of the sedative was at its peak, and because Ryan had endured a sleepless night, the drug affected him more strongly than anticipated. Dr. Gupta encouraged Ryan to lie on the narrow bed in the prep room and rest awhile, until he felt fully alert and capable of driving.

The room was windowless. The overhead fluorescent panels were off, and only a fixture in a soffit above the small sink provided light.

The dark ceiling and shadow-hung walls inspired claustrophobia. Thoughts of caskets and the conqueror worm oppressed him, but the phobic moment quickly passed.

Relief that the procedure had gone well and exhaustion were tranquilizing. Ryan did not expect to sleep, but he slept.

To a discordant melody, he walked a dream road along a valley toward a palace high on a slope. Through the red-litten windows he could see vast forms that moved fantastically, and his heart began to pound, to boom, until it beat away that vision and harried in another.

A wild lake, bound all around with black rocks and tall pines, was lovely in its loneliness. Then the inky water rose in a series of small waves that lapped the shore where he stood, and he knew the lake was a pool of poison. Its gulf would be his grave.

Between these brief dreams and others, he half woke and always found Ismay Clemm at his bedside in the dimly lighted room, once taking his pulse, once with her hand to his forehead, sometimes just watching him, her dark face so shadowed that her oddly lit green eyes seemed to be disembodied.

A few times she spoke to him, and on the first occasion, she murmured, “You hear him, don’t you, child?”

Ryan had insufficient strength to ask of whom she spoke.

The nurse answered her own question: “Yes, you hear him.”

Later, between dreams, she said, “You must not listen, child.”

And later still: “If you hear the iron bells, you come to me.”

When he woke more than an hour after lying down, Ryan was alone.

The one light, the many shadows, and the sparely appointed prep room seemed less real to him than either the palace with windows full of red light or the black lake, or the other places in his dreams.

To confirm that he was awake and that the memory of the biopsy was real, he raised one hand to the small bandage on his neck, which covered the jugular wound, the stitches.

He rose, took off the robe, and dressed in his street clothes.

When Ryan entered the adjacent diagnostics lab, Ismay Clemm was nowhere to be seen. Dr. Gupta and the radiologist had gone, as well.

Nurse Whipset asked if he was all right.

He felt unreal, weightless and drifting, as if he were a ghost, an apparition that she mistook for flesh and blood.

Of course, she wasn’t asking if he felt emotionally sound, only if the sedative had worn off. He answered in the affirmative.

She informed him that the analysis of the biopsy specimens would be expedited. In the interest of greater accuracy and the collection of more precise information, however, Dr. Gupta had ordered the most detailed analysis; he didn’t expect to have the report until Tuesday.

Initially, Ryan intended to ask where he could find Ismay Clemm. He had wanted to ask her what she meant by the strange things she said to him during the brief periods when he had been half-awake.

Now, in the sterile brightness of the diagnostics lab, he was not certain that she had actually spoken to him. She might as easily have been merely a presence in his dreams.

He retrieved his Mercedes from the garage and drove home.

The clear sky presented more birds, more often, than seemed normal. Flocks were strung out in strange formations, a calligraphy of crows in which some meaning might be read if only he knew the language in which it was composed.

At a red traffic light, when he glanced at the silver Lexus in the adjacent lane, he discovered the driver staring at him: a fortysomething man, face hard and expressionless. They locked eyes, and the stranger’s intensity caused Ryan to look away first.

Two blocks later, at another red light, a young man behind the wheel of a chopped and customized Ford pickup was talking on a hands-free cell phone. Fitted to the guy’s ear, the phone stirred in Ryan a memory from an old science-fiction movie: an alien parasite, riding and controlling its human host.

The pickup driver glanced at Ryan, looked immediately away, but a moment later glanced furtively at him once more; and his lips moved faster, as if Ryan were the subject of his phone conversation.