The door to the cath room banged open, and Sally Marcheson breezed in carrying a stack of cassettes. “Hi, Dr. Riggin,” she called.

“Why has this patient been left alone?”

Sally stopped short of the X-ray machine. “Alone?”

“Alone,” repeated Joseph with obvious anger.

“Where’s Gloria? She was supposed…”

“For Christ’s sake, Sally,” shouted Joseph. “Patients are never to be left alone. Can’t you understand that?”

Sally shrugged. “I’ve only been gone fifteen or twenty minutes.”

“And what about all these X rays? Why are they out?”

Sally glanced at the viewers. “I don’t know anything about them. They weren’t here when I left.”

Quickly Sally began pulling the X rays down and stuffing them in the envelope on the countertop. It was someone’s coronary angiogram, and she had no idea whatsoever why the X rays were there.

Still grumbling to himself, Joseph opened a sterile gown and pulled it on. Glancing back at the patient, he saw that the boy had not moved. His eyes still followed him wherever he moved.

With a frightful banging noise, Sally succeeded in loading the cassettes into the machine, then came back to pull off the sterile cover over the cath tray.

While Joseph pulled on rubber gloves, he moved over closer to the patient’s face. “How are you doing, Sam?” For some reason, knowing the boy was retarded made Joseph think he should speak louder than usual. But Sam didn’t respond.

“Do you feel okay, Sam?” called Joseph. “I’m going to have to stick you with a little needle, okay?”

Sam acted as if he were carved from granite.

“I want you to stay very still, okay?” persisted Joseph.

True to form, Sam didn’t budge. Joseph was about to return his attention to the cath tray when Sam’s tongue once again caught his attention. The protruding portion was cracked and dried. Looking closer, Joseph could see that Sam’s lips weren’t much better off. The boy looked like he’d been wandering around in a desert.

“You a little thirsty, Sam?” queried Joseph.

Joseph glanced up at the IV, noticing that it wasn’t running. With a flick of his wrist he turned it on. No sense in the kid becoming dehydrated.

Joseph stepped over to the cath tray and took the gauze out of the prep dishes.

A high-pitched, inhuman scream shattered the stillness of the cath room. Joseph whirled around, his heart in his mouth.

Sam had thrown off his blanket and was clawing at the arm that had the IV. His feet began to hammer up and down on the X-ray table. A shrill cry still issued from his lips.

Joseph collected himself enough to pull the fluoroscopy unit back away from Sam’s thrashing legs. He reached up and put his hands on Sam’s shoulders to push him back onto the table. Instead Sam grasped Joseph’s arm with such power that Joseph yelped out in pain. Powerless to prevent it, Joseph watched with horror as Sam pulled Joseph’s hand up to his mouth, then sank his teeth into the base of Joseph’s thumb.

It was now Joseph’s turn to scream. He struggled to pull his arm from Sam’s grasp, but the boy was far too strong. In desperation Joseph lifted a foot to the side of the X-ray table and pushed. He stumbled back and fell, pulling Sam on top of him.

Joseph felt Sam release his arm only to feel the boy’s hands close around his throat. Pressure built up inside of his head as the boy squeezed. Desperately he tried to pull Sam’s hands away, but they were like steel. The room began to spin. With a last reserve of strength, Joseph brought his knee up into the boy’s groin.

Almost simultaneously, Sam’s body heaved with a sudden contraction. It was rapidly followed by another and then another. Sam was having a grand mal seizure, and Joseph lay pinned to the floor beneath the heaving, convulsing body.

Sally finally recovered from shock and helped Joseph squirm free. Sam’s eyes had disappeared up inside his head and blood sprayed in a gradually widening circle from his mangled tongue

“Get help,” gasped Joseph as he grasped his own wrist to stem the bleeding. Within the jagged edges of the wound he could see the glistening surface of exposed bone.

Before help arrived, Sam’s wrenching spasms weakened and all but stopped. By the time Joseph realized the boy was not breathing, the medical emergency team arrived. They worked feverishly but to no avail. After fifteen minutes, a reluctant Dr. Joseph Riggin was led away to have his hand sutured while Sally Marcheson removed the misplaced X rays.

As Thomas Kingsley scrubbed, he felt the surge of excitement that always possessed him before an operation. He had known he was born to be a surgeon the first time he’d assisted in the OR as an intern, and it hadn’t been long before his skill had been acknowledged throughout the hospital. Now as Boston Memorial’s foremost cardiovascular surgeon, he had an international reputation.

Rinsing off the suds, Thomas lifted his hands to prevent water from running down his arms. He opened the OR door with his hip. As he did so, he could hear the conversation in the room trail off into awed silence. He accepted a towel from the scrub nurse, Teresa Goldberg. For a second their eyes met above their face masks. Thomas liked Teresa. She had a wonderful body that even the bulky surgical gown she was wearing could not hide. Besides, he could yell at her if need be, knowing she wouldn’t burst into tears. She was also smart enough not only to recognize that Thomas was the best surgeon at the Memorial but to tell him so.

Thomas methodically dried his hands while he checked out the patient’s vital signs. Then, like a general reviewing his troops, he moved around the room, nodding to Phil Baxter, the perfusionist, who stood behind his heart-lung machine. It was primed and humming, ready to take over the job of oxygenating the patient’s blood and pumping it around the body while Thomas did his work.

Next Thomas eyed Terence Halainen, the anesthesiologist.

“Everything is stable,” said Terence, alternately squeezing the breathing bag.

“Good,” said Thomas.

Disposing of the towel, Thomas slipped on the sterile gown held by Teresa. Then he thrust his hands into special brown rubber gloves. As if on cue, Dr. Larry Owen, the senior cardiac surgery fellow, looked up from the operative field.

“Mr. Campbell is all ready for you,” said Larry, making room for Thomas to approach the OR table. The patient lay with his chest fully opened in preparation for the famous Dr. Kingsley to do a bypass procedure. At Boston Memorial it was customary for the senior resident or fellow to open as well as close such operations.

Thomas stepped up to his position on the patient’s right. As he always did at this point, he slowly reached into the wound and touched the beating heart. The wet surface of his rubber gloves offered no resistance, and he could feel all the mysterious movement in the pulsating organ.

The touch of the beating heart took Thomas’s mind back to his first major case as a resident in thoracic surgery. He had been involved in many operations prior to that, but always as the first assistant, or second assistant, or somewhere down the line of authority. Then a patient named Walter Nazzaro had been admitted to the hospital. Nazzaro had had a massive heart attack and was not expected to live. But he did. Not only did he survive his heart attack, but he survived the rigorous evaluation that the house staff doctors put him through. The results of the work-up were impressive. Everyone wondered how Walter Nazzaro had lived as long as he had. He had occlusive disease in his main left coronary artery, which had been responsible for his heart attack. He also had occlusive disease in his right coronary artery with evidence of an old heart attack. In addition he had mitral and aortic valve disease. Then, as if that weren’t enough, Walter had developed an aneurysm, or a ballooning of the wall, of his left ventricle of his heart as a result of the most recent heart attack. He also had an irregular heart rhythm, high blood pressure, and kidney disease.