“It’s such an irreversible decision,” Mr. Lowell was saying nervously.

“But still a decision that must be made,” said Thomas, standing up and closing Mr. Lowell’s folder. “Unfortunately I’m on a tight schedule. If you have any further questions you can call.” Thomas started for the door like a clever salesman indicating the issue was beyond further negotiation.

“What about the advisability of a second opinion?” asked Mr. Lowell hesitantly.

“Mr. Lowell,” said Thomas, “you can get as many opinions as you’d like. I will be sending a full consult letter back to Dr. Whiting, and you can discuss the case with him.” Thomas opened the door leading to the waiting room. “In fact, Mr. Lowell, I would encourage you to see another surgeon because, frankly, I do not feel good about working with people with negative attitudes. Now if you’ll excuse me.”

Thomas closed the door behind Mr. Lowell, confident the man would schedule the required operation. Sitting down, he gathered the material he needed for his Grand Rounds presentation the following morning, and then started signing the consultation letters Doris had left for him.

When Thomas emerged with the signed correspondence, he was not surprised to find Mr. Lowell in the waiting room. Thomas glanced at Cassi, acknowledging her with a brief nod, then turned to his patient.

“Dr. Kingsley, I’ve decided to go ahead with the operation.”

“Very well,” said Thomas. “Give Miss Stratford a call next week, and she’ll set it up.”

Mr. Lowell thanked Thomas and left, closing the door quietly behind him.

Holding her reports in front of her as if she were reading, Cassi watched her husband going over some notes with Doris. She’d noticed how well he’d handled Mr. Lowell. He never seemed to hesitate. He knew what should be done and he did it. She’d always admired his composure, a quality she felt she lacked. Cassi smiled as her eyes traced the sharp lines of his profile, his sandy hair, and his athletic body. She found him extraordinarily attractive.

After the insecurities of the day, in fact the entire week, Cassi wanted to rush up and throw her arms around him. But she knew instinctively that he would not care for that kind of show of emotion, especially with Doris there. And Cassi knew he was right. The office was not the place for such behavior. Instead, she put the reprint back into the folder and the folder back into the canvas bag.

Thomas finished with Doris, but it wasn’t until the office door closed behind them that he spoke to Cassi.

“I’ve got to go to the ICU,” he said, his voice flat. “You can come or wait in the lobby. Your choice. I won’t be long.”

“I’ll come,” said Cassi, already guessing that Thomas’s day had not been smooth. She had to quicken her step to keep up with him.

“Was there trouble with your surgery today?” she asked tentatively.

“Surgery went fine.”

Cassi decided against further questioning. It was difficult to talk as they threaded their way back into the Scherington Building. Besides, she’d learned from experience that it was usually better to let Thomas volunteer information when he was upset.

In the elevator she watched while he kept his eyes glued to the floor indicator. He seemed tense and preoccupied.

“I’ll be glad to get home tonight,” said Cassi. “I need a good night’s sleep.”

“The weirdos keep you busy last night?”

“Let’s not have any of your surgeon’s opinions about psychiatry,” said Cassi.

Thomas didn’t respond, but an ironic smile appeared on his face, and he seemed to relax a little.

The elevator doors opened on seventeen, and they got out. Thomas walked swiftly ahead. No matter how many years Cassi had spent in hospitals, she always had the same reaction when she found herself on the surgical floor. If it wasn’t fear, it was close to it. The crisis aspect undermined the elaborate denial she used about the implications of her own illness. What mystified Cassi about the response was that she didn’t feel the same way on the medical floor where there invariably were patients with diabetically induced complications.

As Cassi and Thomas neared the ICU, several waiting relatives recognized Thomas. Like a movie or rock star, he was instantly surrounded. One old woman was intent on touching him as if he were some kind of god. Thomas remained composed, assuring everyone that all the surgery had gone routinely and that they would have to wait for further updates by the nursing personnel. With some difficulty he finally detached himself and entered the ICU where no one dared follow him except Cassi.

With its enormous number of machines, oscilloscope screens, and bandages, it intensified all of Cassi’s unspoken fears. And in fact, the patients themselves seemed all but forgotten, lost as they were in the tangle of equipment. The nurses and doctors seemed to tend the machines first.

Thomas went from bed to bed. Each patient in the ICU had his own specially trained nurse to whom Thomas spoke, hardly looking at the patient unless the nurse called his attention to some abnormality. He visually checked all the vital signs which could be seen on the read-out equipment. He glanced at the fluid balance logs, held portable chest X rays up to the overhead light, and looked at electrolyte and blood gas values. Cassi knew enough to know how much she didn’t know.

As Thomas had promised, he didn’t take long. His patients were all doing well. With Larry Owen in command, the resident staff would deal with all the minor problems that arose during the night. When Thomas and Cassi reemerged, the patients’ families again set upon him. Thomas said that he regretted he didn’t have more time to talk but that everyone was doing well.

“It must be extraordinarily rewarding to get that kind of feedback from families,” said Cassi as they were walking toward the elevator.

Thomas didn’t respond immediately. Cassi’s statement reminded him of the pleasure he had felt years earlier when the Nazzaros had greeted him. Their gratitude had meant something. Then he thought about Mr. Campbell’s daughter. He glanced back down the corridor, realizing that he hadn’t seen her.

“Oh, it’s nice that the relatives are appreciative,” said Thomas without much feeling. “But it’s not that important. It’s certainly not why I do surgery.”

“Of course not,” said Cassi. “I didn’t mean to imply that.”

“For me recognition by my teachers and superiors was always more important,” said Thomas.

The elevator arrived and they got on.

“The trouble is,” continued Thomas, “now I’m the teacher.”

Cassi glanced up. To her surprise his voice had an unexpected and uncharacteristic wistfulness. As she watched him, she could see that he was staring ahead, daydreaming.

Thomas’s mind flashed back to his thoracic residency, a time of unbelievable excitement and adventure. He remembered that he all but lived in the hospital for three years, going home to his drab two-room apartment only to recharge by sleeping for a few hours. In order to excel he had worked harder than he’d ever thought possible. And in the end he was appointed chief resident. In many respects Thomas felt that event had been the crowning achievement of his life. He’d come out on top of a group of gifted people as committed and competitive as himself. Thomas would never forget the moment that each of his attendings congratulated him. There was no doubt, he thought, that surgery and life in general were more rewarding and more fun then. Thankful relatives were nice, but they were no substitute.

When Cassi and Thomas emerged from the hospital, they were rudely slapped by a wet Boston evening. Gusts of wind lashed the rain in chaotic circles. At six-fifteen it was already dark. The only illumination came from the city lights reflecting off the low, swirling cloud cover. Cassi grasped Thomas about the waist and together they ran for the nearby parking garage.