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“I wish there was something I could do for you,” whispered Laura, her arms still tightly wrapped around Thomas’s neck. “Anything.”

Thomas looked down at the curve of her buttocks, accentuated by the silk dress that hugged her form. Disturbingly he could feel her thighs pressed against his own, and he knew he had to get away. Reaching up, he detached Laura’s encircling arms.

“You’ll be able to talk with your father in the morning,” said Thomas.

She nodded, suddenly embarrassed by her behavior.

Thomas left her and walked from the waiting room with a feeling of anxiety that he did not understand. He wondered if it was fatigue, although he had not felt tired earlier even though he’d been up a good portion of the previous night on an emergency operation. Returning the white coat to the rack, he tried to shrug off his mood.

Before going into the lounge, Thomas paid a visit to the recovery room. His two previous cases, Victor Marlborough and Gwendolen Hasbruck, were stable and doing predictably well, but as he looked down at their faces he felt his anxiety increase. He wouldn’t have recognized them in a crowd although he’d held their hearts in his hand just hours before.

Feeling distracted and irritated by the forced camaraderie of the recovery room, Thomas retreated to the surgical lounge. He didn’t particularly care for the taste of coffee, but he poured himself a cup and took it over to one of the overstuffed leather armchairs in the far corner. The living section of the Boston Globe was on the floor, and he picked it up, more as a defense than for what it contained. Thomas didn’t feel like being trapped into small talk with any of the OR personnel. But the ploy didn’t work.

“Thanks for the help in the waiting room.”

Thomas lowered the paper and looked up into the broad face of George Sherman. He had a heavy beard, and by that time in the afternoon it appeared as if he’d forgotten to shave that morning. He was a stocky, athletic-looking man an inch or two shorter than Thomas’s six feet, but his thick, curly hair made him look the same height. He had already changed back to his street clothes, which included a wrinkled blue button-down shirt that appeared as if it had never felt the flat surface of an iron, a striped tie, and a corduroy jacket somewhat threadbare on the elbows.

George Sherman was one of the few unmarried surgeons. What put him in a unique class was that at age forty he’d never been married. The other bachelors were either separated or divorced. And George was a particular favorite among the younger nurses. They loved to tease him about his errant bachelor’s life, offering help in various ways. George’s intelligence and humor took all this in stride, and he milked it for all it was worth. Thomas found it all exceedingly irritating.

“The poor woman was pretty upset,” said Thomas. Once again he had to refrain from making some comment concerning the advisability of bringing such a case into the hospital. Instead he raised his paper.

“It was an unexpected complication,” said George, undeterred. “I understand that good-looking chick in the waiting room was your patient’s daughter.” Thomas slowly lowered his paper again.

“I didn’t notice she was particularly attractive,” Thomas said shortly.

“Then how about sharing her name and phone number?” said George with a chuckle. When Thomas failed to respond, George tactfully changed the subject. “Did you hear that one of Ballantine’s patients arrested and died during the night?”

“I was aware of it,” said Thomas.

“The guy was an admitted homosexual,” said George.

“That I didn’t know,” said Thomas with disinterest. “I also didn’t know that the presence or absence of homosexuality was part of a routine cardiac surgical work-up.”

“It should be,” said George.

“And why do you think so?” asked Thomas.

“You’ll find out,” said George, raising an eyebrow. “Tomorrow in Grand Rounds.”

“I can’t wait,” said Thomas.

“See you in conference this afternoon, sport,” said George, giving Thomas a playful thump on the shoulder.

Thomas watched the man saunter away from him. It annoyed him to be touched and pummeled like that. It seemed so juvenile. While he watched, George joined a group of residents and scrub nurses slumped over several chairs near the window. Laughter and raised voices drifted across the room. The truth was that Thomas could not stand George Sherman. He was convinced George was a man bent on accumulating the trappings of success to cover a basic mediocrity in surgical skill. It was all too familiar to Thomas. One of the seemingly inadvertent evils of the academic medical center was that appointments were more political than anything else. And George was political. He was quick-witted, a good conversationalist, and socialized easily. Most important, he thrived within the bureaucratic committee system of hospital politics. He’d learned early that for success it was more important to study Machiavelli than Halstead. Thomas knew that the root of the problem was an antagonism between the doctors on the teaching staff like himself, who had private practices and earned their incomes by billing their patients, and the doctors like George Sherman, who were full-time employees of the medical school and received salaries instead of fees for service. The private doctors had substantially higher incomes and more freedom. They did not have to submit to a higher authority. The full-time doctors had more impressive titles and easier schedules, but there was always someone over them to tell them what to do.

The hospital was caught in the middle. It liked the high census and money brought in by the private doctors, and, at the same time, it enjoyed the credibility and status of being part of the university medical school.

“Campbell’s chest is closed,” said Larry, interrupting Thomas’s thoughts.

“The residents are closing the skin. All signs are stable and normal.”

Tossing the newspaper aside, Thomas got up from the chair and followed Larry toward the dressing room. As he passed behind George, Thomas could hear him talking about forming some kind of new teaching committee. It never stopped! Nor did the pressure that George, as head of the teaching service, and Ballantine, as head of the department, applied to Thomas, trying to convince him to give up his practice and join the full-time staff. They tried to entice him by offering him a full professorship, and although there’d been a time when that might have interested Thomas, now it held no appeal whatsoever. He’d keep his practice, his autonomy, his income, and his sanity. Thomas knew if he went fulltime it would only be a matter of time before he was told who he could and who he could not operate on. Before long he’d be assigned ridiculous cases like the poor mentally retarded kid in the cath room.

Tense and angry, Thomas went into the dressing area and opened his locker. As he pulled off his scrub clothes and tossed them into the hamper, he recalled Laura Campbell’s pliant body pressed against his own. It was a welcome and pleasant image and had the effect of mollifying his frazzled nerves. Ever since he’d left the OR, his pleasure in operating had dissipated, leaving him increasingly tense.

“As usual, you did a superb job today,” said Larry, noting Thomas’s grim face and hoping to please him.

Thomas didn’t respond. In the past he would have loved such a compliment, but now it didn’t seem to make any difference.

“It’s too bad that people can’t appreciate the details,” said Larry, buttoning his shirt. “They’d have a totally different idea of surgery if they did. They’d also be more careful who they let operate on them.”

Thomas still did not say anything, although he nodded at the truth of the comment. As he pulled on his own shirt, he thought of Norman Ballantine, that white-haired, friendly old doc whom everyone loved and applauded. The fact of the matter was that Ballantine probably shouldn’t still be operating, although no one had the nerve to tell him. It was common knowledge in the department that one of the chief thoracic resident’s jobs was to assign himself to all of Ballantine’s cases so that he could help the chief when he blundered. So much for academic medicine, thought Thomas. Ballantine, thanks to the residents, got reasonable results, and his patients and their families worshipped him despite what went on when the patient was anesthetized.

Thomas had to agree with Larry’s comment. He also thought that it would be infinitely more appropriate if he, Dr. Thomas Kingsley, was chief. After all, he did most of the surgery, for God’s sake. It was he, more than any other single person, who had made Boston Memorial the place to have any cardiac surgery. Even Time magazine had said as much.

Yet Thomas did not know if he wanted to be chief any longer. At one time it was all he could think about. It had been one of his driving forces, pushing him on to greater efforts and more personal sacrifice. It had seemed part of a natural progression, and colleagues had started talking about it while he was still a fellow. But that was quite a few years ago, before all the administrative bullshit had reared its ugly head and showed just how much it could interfere in his practice.

Thomas stopped dressing and stared ahead into the distance. He felt an emptiness inside of him. Comprehending that one of his long sought-after goals was potentially no longer attractive was depressing, especially when the goal was finally within his grasp. Maybe there was no place to go ... maybe he’d reached his apogee. God, what an awful thought!

“I’m awfully sorry to hear about your wife,” said Larry as he sat down to put on his shoes. “It really is a shame.”

“What do you mean?” asked Thomas, pronouncing each word with deliberate precision. He took immediate offense that a subordinate like Larry would presume to be so familiar.

Larry, oblivious to Thomas’s response, bent to tie his shoes. “I mean about her diabetes and her eye problem. I heard she’s got to have a vitrectomy. That’s terrible.”

“The surgery is not definite,” snapped Thomas.

Hearing the anger in Thomas’s voice, Larry looked up. “I didn’t mean it was necessarily definite,” he managed. “I’m sorry I brought it up. It must be difficult for you. I just hoped that she was okay.”

“My wife is perfectly fine,” said Thomas angrily. “Furthermore, I don’t think that her health is any of your business.”

“I’m sorry.”

There was an uncomfortable silence as Larry quickly finished with his shoes. Thomas tied his tie and splashed on Yves St. Laurent cologne with rapid, irritated motions.

“Where did you hear this rumor?” asked Thomas.

“From a pathology resident,” said Larry. “Robert Seibert.” Larry closed his locker and told Thomas he’d be in the recovery room if he was needed.

Thomas ran a comb through his hair, trying to calm down. It just wasn’t his day. Everyone seemed intent on upsetting him. The idea that his wife’s ill health was a topic of idle conversation among the resident staff seemed inexplicably galling. It was also humiliating.

Placing the comb back in his locker, Thomas noticed a small plastic container. Feeling a rising inner tension and the stirrings of a headache, he flipped open the lid of the bottle. Snapping one of the scored yellow tablets in two, he popped the half into his mouth. Hesitant, he then popped in the other half as well. After all, he deserved it.

The tablets tasted bitter, and he needed a drink from the fountain to wash them down. But almost immediately he felt relief from his growing anxiety.

The Friday afternoon cardiac surgery conference was held in the Turner surgical teaching room diagonally across the hall from the surgical intensive care unit. It had been donated by the wife of a Mr. J. P. Turner, who’d died in the late nineteen-thirties, and the decor had an Art Deco flavor. The room provided seating for sixty, half the medical school class size in 1939. In the front there was a raised podium, a dusty blackboard, an overhead rack of ancient anatomy charts, and a standing skeleton. It had been at Dr. Norman Ballantine’s insistence that the Friday meeting be held in the Turner teaching room because it was close to the ward, and, as Dr. Ballantine put it, “It is the patients that it’s all about.” But the small group of a dozen or so looked lost among the sea of empty seats and distinctly uncomfortable behind the spartanly designed desks.

“I think we should get the meeting under way,” called Dr. Ballantine over the hum of conversation. The people took their seats. Present at the meeting were six of the eight cardiac surgeons on staff, including Ballantine, Sherman, and Kingsley, as well as various other doctors and administrators, and a relatively new addition, Rodney Stoddard, philosopher.

Thomas watched Rodney Stoddard sit down. He looked like he was in his late twenties despite the fact that he was mostly bald and his remaining hair was such a light color that it was difficult to see it. He wore thin wire-rimmed glasses and an expression of constant self-satisfaction. To Thomas it seemed as if the man were saying, “Ask me about your problem because I know the answer.”

Stoddard had been hired at the university’s insistence. Until recently doctors were committed to trying to save all their patients. But now, with the advent of such expensive and complicated procedures as open-heart surgery, transplants, and artificial organs, hospitals had to pick and choose to whom to give these life-saving operations. For the time being, these techniques were limited by extraordinary costs and by the space available in the sophisticated units needed for aftercare. In general the teaching staff tended to favor patients with multisystemic disease, who did not always do well, while private physicians such as Thomas leaned toward otherwise healthy, productive members of society.