Doris’s voice mixed with static greeted him over the intercom when he pushed her bell. He started up the stairs and heard her door open.

“What a nice surprise,” she called as he rounded the first landing. She was dressed in a skimpy jogging outfit of shorts and a T-shirt that barely covered her navel. Her hair was loose and seemed incredibly thick and shiny.

As she led him inside and closed the door, Thomas glanced around the apartment. He hadn’t been there for months, but not much had changed. The living room was tiny, with a single couch facing a small fireplace. At the end of the room was a bay window that overlooked the street. On the coffee table were a decanter and two glasses. Doris walked up to Thomas and leaned against him. “Did you want to dictate a little?” she teased, running her hands down his back. Thomas’s fears about his potency quickly vanished.

“It’s not too early for a little fun, is it?” asked Doris, pressing herself against Thomas and sensing his arousal.

“God, no,” said Thomas, pulling her down onto the couch and yanking off her clothes in an ecstasy of excitement and relief at his own response. As he plunged into her he comforted himself that the problem that he’d experienced the night before was Cassi’s, not his. It never occurred to him that he had yet to take a Percodan that day.

The nurses in the surgical intensive care unit knew that problems, particularly serious problems, had an uncanny way of propagating themselves. The night had begun badly with the eleven-thirty arrest of an eleven-year-old girl who’d been operated on that day for a ruptured spleen. Luckily things had worked out well, and the child’s heart had begun beating again almost immediately. The nurses had been amazed at the number of doctors who had responded to the code. For a time there had been so many doctors that they’d been falling over each other.

“I wonder why there are so many attendings in the house?” asked Andrea Bryant, the night supervisor. “It’s the first time I’ve seen Dr. Sherman here on a Saturday night since he was a resident.”

“Must be a lot of emergency cases in the OR,” said the other RN, Trudy Bodanowitz.

“That can’t be it,” said Andrea. “I spoke to the night supervisor there and she said that there were only two: an emergency cardiac case and a fractured hip.”

“Beats me,” said Trudy, looking at her watch. It was just after midnight. “Do you want to take first break tonight?”

The girls were sitting at the central desk finishing the paperwork engendered by the arrest. Neither was assigned to specific patients but rather manned the central station and performed the necessary administrative functions.

“I’m not sure either of us is going to get a break,” said Andrea, looking around the large U-shaped desk. “This place is a mess. There’s nothing like having an arrest right after shift change to spoil routine.”

The nurses’ station in the ICU rivaled the flight deck of a Boeing 747 for complicated electronic equipment. Facing the women were banks of TV screens giving constant read-outs on all the patients in the unit. Most were set within certain limits so that alarms would go off if the values strayed too far from normal. While the women were speaking, one of the EKG tracings was changing. As crucial minutes passed, the previously regular tracing began to look more and more erratic. Finally, the alarm went off.

“Oh shit,” said Trudy as she looked up at the beeping oscilloscope screen. She stood up and gave the unit a slap with her hand, hoping that an electrical malfunction was the cause of the alarm. She saw the abnormal EKG pattern and switched to another lead, still hoping the problem was mechanical.

“Who is it?” asked Andrea, checking for any evidence of frantic activities on the part of the nursing staff.

“Harwick,” said Trudy.

Andrea’s gaze quickly switched over to the bed of Dr. Ballantine’s OR disaster. There was no nurse in attendance, which was not unusual. Mr. Harwick had been exceptionally stable over the last weeks.

“Call the surgical resident,” said Trudy. Mr. Harwick’s EKG was deteriorating even as Trudy watched. “Look at this, he’s going to arrest.”

She pointed to the screen where Mr. Harwick’s EKG was showing typical changes before it either stopped or degenerated to ventricular fibrillation.

“Should I call a code?” asked Andrea.

The two women looked at each other.

“Dr. Ballantine specifically said ‘no code,’ ” said Trudy.

“I know,” said Andrea.

“It always gives me an awful feeling,” said Trudy, looking back at the EKG. “I wish they wouldn’t put us in this position. It’s not fair.”

While Trudy watched, the EKG line flattened out with just an occasional blip. Mr. Harwick had died.

“Call the resident,” said Trudy angrily. She walked around the end of the ICU desk and approached Mr. Harwick’s bed. The respirator was still inflating and deflating his lungs, giving him the appearance of life.

“Certainly doesn’t make you excited about having surgery,” said Andrea, hanging up the phone.

“I wonder what went wrong. He was so stable,” said Trudy.

Trudy reached out and flipped off the respirator. The hissing sound stopped. Mr. Harwick’s chest fell and was still.

Andrea reached over and turned off the IV. “It’s probably just as well. Now the family can adjust and then go on with their lives.”

Five

Two weeks had passed since Thomas learned of Cassi’s visit to his mother. While they had only fought briefly, the tension had been unbearable. Even Thomas had noted his increased dependency on Percodan, but he had to take something to allay his anxiety.

As he ran down the hall late for the monthly death conference, he felt his pulse race.

The meeting had already begun, and the chief surgical resident was presenting the first case, a trauma victim who had expired shortly after admission to the ER. The resident and intern had failed to notice warning signs that the sac covering the heart had been damaged and was filling with blood. Since no attending had been involved, the doctors happily raked the house staff over the coals.

If the case had belonged to one of the private staff men, the discussion would have progressed very differently. The same points would have been made, but the physician would have been reassured that the diagnosis of hemopericardium was difficult and he’d done the best he could.

Thomas had realized early in the game that the monthly death conference served more to relieve guilt than to punish, unless the offender was a resident. Lay people might have thought the death conference served as a kind of watchdog, but unfortunately such was not the case, as Thomas cynically observed. And the next case proved his point.

Dr. Ballantine was mounting the podium to present Herbert Harwick. When he finished, an obese pathology resident quickly ran down the results of the autopsy, including slides of the individual’s brain, of which little remained.

Mr. Harwick’s death was then discussed but with no mention that his trauma in the OR was the possible result of Dr. Ballantine’s inept surgery. The general feeling among the attendings was, “There but for the grace of God go I,” which was true to an extent. What made Thomas sick was that no one remembered that six months previously Ballantine had presented a similar case. Air embolism was a feared complication that at times occurred no matter what one did, but the fact that it occurred so often and at an increasing frequency to Ballantine was always ignored.

Equally amazing, as far as Thomas was concerned, was that nothing was said about Harwick’s actual death in the ICU. As far as Thomas knew, the patient had been stable for an extended period of time before the sudden arrest. Thomas looked at the members of the audience and puzzled why they remained silent. It reconfirmed for him that bureaucracy and its committee method of dealing with problems was no way to run an organization.