The young resident with the name tag John Richardson looked up and spoke with quick precision.

"We're not sure yet. He's suffering severe abdominal pain. Physical examination is remarkable for the liver being palpable four centimeters below the right costal margin. It's extremely tender."

"Hurts like hell is more like it," Michael managed from his prone position on the table.

"Vital signs?"

"All stable."

Harvey moved toward the bed.

"Looking good, champ."

"Feel like shit, coach."

"I was only kidding. You look like shit too."

Michael managed a chuckle.

"I got the varsity in here now.

How's it going, Eric?"

"Fine. Should I page Dr. Sagarel, Harv?"

Harvey nodded.

"See you in a bit, Mike," Eric said.

"I'll wait here for you." Michael turned his attention back to Harvey.

"Who is Dr. Sagarel?"

"A gastroenterologist."

"Of course. I should have known."

"Jesus, Michael, look at your shorts. They're horrendous even by your standards."

"I ask for a doctor. I get a fashion critic."

Harvey probed the liver area.

"Does that hurt?"

"Like a son of a bitch."

Harvey straightened his back and turned toward the resident.

"Have you done the blood work yet?"

"Yes."

"Get him an abdominal flat plate done stat."

"I'll also need to get a better history," Richardson said.

"It could be something he consumed "

"Can't be. He's had this pain for weeks. And his skin is jaundiced."

Eric came back into the room.

"Dr. Sagarel will be here in about a half hour." "Michael," Harvey asked, "have you noticed anything unusual in your urine lately?"

"A Datson hatchback came out the other day."

"Hilarious. Now answer my question."

Harvey saw the fear gather around Michael's eyes.

"I don't know. The color's been darker maybe."

The doctor's exchanged knowing glances.

"What?" Michael asked.

"What have I got?"

"I don't know yet. Eric, make sure they do a Hep screen on the blood.

Also EBV and CMV titers. Then bring him down for an abdominal ultrasound."

"One step ahead of you."

"Now in English?" Michael asked.

"All the signs point to hepatitis," Harvey explained.

"Eric and Dr. Richardson are going to take you downstairs for x-rays now, I'll see you in a little while."

Dr. Raymond Markey, Assistant Secretary for Health of the Department of Health and Human Services, stared out the window at the lush green compound in Bethesda, Maryland. To him, the National Institutes of Health resembled a cross between a European spa and a military base.

From his corner office the wilderness seemed to stretch for miles. But Markey knew better.

He knew, for instance, that his big boss, the President of the United States, was about ten miles away, beginning his weekly brunch meeting with the Vice President. The two men met most Mondays for a light brunch and a heavy discussion. Raymond had attended a few of those brunches. He did not particularly care for the conversation or the food.

He sighed deeply, took off his glasses, and rubbed his eyes.

He was excruciatingly nearsighted. When he viewed the sprawling landscape without his glasses, the world turned into a large abstract painting. The bright colors bled into one another and seemed to move in a kaleidoscope pattern.

He put his glasses back on, turned away from the calming view, and glanced at the two reports on his desk. The first was marked "Confidential!" and there were numerous seal protectors on the envelope so that Markey could be sure that no one had opened it before him. The envelope was also specially treated so that its contents could not be read by holding it up to a light.

Any tampering left permanent scars. It was a lot of security, but ' sometimes every bit of it was needed. n The second envelope read "Sidney Pavilion, Columbia!

Presbyterian Medical Center, New York." The security surrounding this file, while significant, was somewhat more limited.

Assistant Secretary for Health of the Department of Health and Human Services a long and rather unimpressive title, Raymond Markey thought.

But he knew better. His office was in charge of the U.S. Public Health Service, controlling such agencies as the Food and Drug Administration, the Centers for Disease Control, and the National Institutes of Health hardly an unimportant or ceremonial post.

Markey reached for his letter opener and slit the confidential envelope. He then laid the reports side by side. The regular report had been filled out by Dr. Harvey Riker and for the first time Dr. Brace Grey's signature had been omitted. Too bad. As for the confidential report... well, safer not to think about the source.

Repeating the name of the author out loud could prove hazardous to one's health. Even fatal.

Markey skimmed the files for obvious discrepancies. One jumped out at him immediately.

The number of patients.

According to Hiker's report, they had been treating forty-one patients, two of whom had been murdered in recent weeks.

Riker's write-up was factual, not drawing any conclusions, but he did mention the strange coincidence that two patients had died of multiple stab wounds within a couple of weeks of one another. Markey also noticed that Riker never referred to Grey's death as a suicide but as a "shock" and "death that made no sense."

Curious description, Markey mused.

He examined the reports again. The report stamped "Confidential"

stated unequivocally that there had originally been forty-two patients, not forty-one. Why the discrepancy? Markey wondered. Raymond doubted very much it was a mistake. No one made mistakes in these situations.

There was a reason for the discrepancy. All he had to do was figure out what.

Markey thumbed back to the beginning of the confidential report. He was sure that Harvey Riker was behind the discrepancy. He knew Riker well and did not trust him. Many years earlier, when Raymond Markey had been chief of staff at St. Barnabas Hospital in New Jersey, he had first encountered a brash, young intern named Harvey Riker. Even back then Riker hated rules and regulations. And now that those rules and regulations came from the government, Markey knew Riker was even more apt to bend them. The man had tremendous talent but very little discipline. He needed to be watched. Closely.

Ah, here it was. On page two.

Page two of the confidential report listed all the staff members and patients at the Sidney Pavilion. Markey shifted through Rikef's report until he found the patient list. He counted them.

Yes, forty-two in the confidential report. Forty-one in the doctor's report. Which name was missing from Dr. Riker's file?

It did not take long to find. The name might as well have been underlined.

His hand shaking, Raymond picked up the phone behind his desk. The office phone was probably bugged, but he carefully screened his private line on a daily basis. Can't be too careful.

He dialed. The receiver on the other end was picked up after three rings.

"Yes?"

"I have the confidential report. It arrived this morning."

"And?"

Markey swallowed.

"I haven't had a chance to go through it completely yet, but I think we better move fast. They're getting close."

"Then we might have to send someone to Bangkok. When can I get a copy?"

"I'll mail it out today."

"Good."

"There's something else."

"Yes."

"Dr. Riker is secretly working on an important patient," Markey said.

"He left the name out of his report."

"Who is it?"

"Bradley Jenkins. The senator's "

"I know who he is." There was a brief silence.

"That explains a lot of things, Raymond." "I know," Markey said.

"Get me that report right away."