"I wouldn't expect anything different," Tom joked. He knew Kim well enough to recognize his style of humor.

The two surgeons returned to the operating table. This time Tom was on the patient's right.

"All right, everybody," Tom said. "Let's get that cannula in. Scalpel, please!"

With Tom at the helm, the operation went smoothly. Although Kim was on the patient's left, he was the one who positioned the valve and placed the initial sutures. Tom did the rest. As soon as the sternum was closed, Tom suggested Kim should bow out.

"You don't mind?" Kim asked.

"Hell, no," Tom said. "Get over there and check on Becky."

"Thanks," Kim said. He stepped back and pulled off his gown and gloves.

As Kim pulled open the heavy OR door, Tom called out: "Between myself and Jane, we'll write the post-op orders. If there's anything else I can do, just call."

"I appreciate it," Kim said. He hurried into the surgical locker room where he picked up a long white coat to pull on over his scrubs. He was eager to get to the ICU and didn't want to take the time to change back into his street clothes.

Kim had visited the intensive-care unit prior to and between each of his surgeries. Becky had shown some improvement, and there was some talk of trying to wean her off the respirator. Kim hadn't allowed himself to become too hopeful, knowing she'd been on for less than twenty-four hours.

Kim had even found time prior to his first case to phone George again to ask if he could think of anything else they could do for Becky. Unfortunately he hadn't had any suggestions, except for plasmaphoresis, which he didn't recommend.

Kim had come across plasmaphoresis for E. coli 0157:H7 toxemia in his research in the library during Becky's surgery. It involved replacing the patient's plasma with pooled fresh frozen plasma. Unfortunately it was a controversial treatment considered experimental with an enormous attendant risk of HIV since the new plasma came from hundreds of different donors.

The doors to the elevator opened and Kim was dismayed to join a group of happy staffers leaving the hospital at the end of the day shift. He knew it was unreasonable of him, but he couldn't help but be annoyed by their cheerful babble.

Getting off the elevator, Kim started down the hall. The closer he got to the ICU, the more nervous he became. He was almost beginning to feel a premonition.

He paused at the waiting-room threshold to see if Tracy was there. He knew she'd planned on going home to clean up and change clothes.

Kim saw her sitting in a chair near the window. She spotted him at almost the same moment and stood up. As she approached, Kim could see there'd been fresh tears. They streaked the side of her face.

"What's wrong now?" he asked with dismay. "Has there been a change?"

For a moment Tracy could not speak. Kim's question brought forth new tears that she had to choke back. "She's worse," Tracy managed. "Dr. Stevens talked about a cascading pattern of major organ failure. It was so much mumbo-jumbo to me, but she said that we should prepare ourselves. I think she was saying that Becky may die!"

"Becky's not going to die!" Kim said with vehemence that bordered on anger. "What happened to make her suggest such a thing?"

"Becky has had a stroke," Tracy said. "They think she's blind."

Kim shut his eyes hard. The idea of his ten-year-old daughter having a stroke seemed beyond any realm of possibility. Yet Kim well understood that her clinical course had been spiraling downward from the outset. That she may have reached the point of no return was not entirely surprising.

Leaving Tracy in the waiting room, Kim strode across the hall and entered the ICU. Mirroring the previous afternoon, a gaggle of doctors were pressed into Becky's cubicle. Kim pushed his way in. He saw a new face: Dr. Sidney Hampton, neurology.

"Dr. Reggis," Claire called.

Kim ignored the pediatrician. He muscled his way to the bedside and looked at his daughter. She was a pitiful shadow of her former self, lost within the wires and tubes, and the technology. Liquid crystal displays and monitor screens flashed their information in the form of digital readouts and tracing cursors.

Becky's eyes were closed. Her skin was a translucent bluish white.

"Becky, it's me, Dad," Kim whispered into her ear. He studied her frozen face. She didn't register any sign of hearing him.

"Unfortunately she's unresponsive," Claire said.

Kim straightened up. His breaths were shallow and rapid. "You think she's had a stroke?"

"Every indication suggests as much," Sidney said.

Kim had to remind himself not to blame the messenger.

"The basic problem is that the toxin seems to be destroying her platelets as fast as we give them," Walter said.

"It's true," Sidney said. "There's no way to know if this was an intracranial hemorrhage or a platelet embolus."

"Or a combination of the two," Walter suggested.

"That's a possibility," Sidney admitted.

"One way or another," Walter added, "the rapid destruction of her platelets must be forming a sludge in her microcirculation. We're into that cascading major organ failure situation that we hate to see.

"Kidney and liver function is definitely going down," Arthur said. "The peritoneal dialysis is not keeping up."

Kim had to steel himself to curtail his anger at this self-serving dialectic. It certainly wasn't helping his daughter. He tried to think and remain rational.

"If the peritoneal dialysis is not working," Kim said in a deceptively calm voice, "perhaps we should transfer her to the Suburban Hospital and get her on a dialysis machine."

"That's out of the question," Claire said. "She's too critical to be transferred."

"Well, it seems to me we-have to do something," Kim shot back, his anger bubbling to the surface.

"I think we are doing all we can," Claire said. "We're actively supporting her respiratory and kidney functions, and replacing her platelets."

"What about plasmaphoresis?" Kim said.

Claire looked at Walter.

"AmeriCare is reluctant to authorize it," Walter said.

"Screw AmeriCare," Kim spat. "If there's a chance you think it could help, let's do it."

"Hold on, Dr. Reggis," Walter said. The gray-haired man shifted his weight. He was obviously uncomfortable about this issue. "AmeriCare owns this hospital. We can't just go thumbing our noses at their rules. Plasmaphoresis is expensive and experimental. With lay families, I'm not even supposed to bring it up."

"How do we go about getting them to authorize it?" Kim questioned. "I'll pay for it myself if it can help."

"I'd have to call Dr. Norman Shapiro," Walter said. "He's the chairman of the AmeriCare Review Board."

"Call him!" Kim barked. "Right now!"

Walter looked at Claire. Claire shrugged. "I suppose a call can't hurt."

"Okay by me," Walter said. He left the room to use the phone at the ICU desk.

"Dr. Reggis, plasmaphoresis is grasping at straws," Claire said. "I think it's only fair to tell you and your former wife that you should be preparing yourselves for all eventualities."

Kim saw red. He was in no frame of mind to "prepare himself" as Claire euphemistically suggested. Instead he wanted to strike out at the people responsible for Becky's sorry state, and at that moment his nearest targets were the doctors in that very room.

"You do understand what I'm saying, don't you?" Claire asked gently.

Kim didn't answer. In a suddenly clairvoyant moment, he comprehended the absurdity of blaming these doctors for Becky's plight, especially when he knew where the fault lay.

Without warning, Kim broke away from Claire and rushed out of the ICU. He was beside himself with anger, frustration, and his humiliating sense of impotence. He started down the hall.