of the artificial lung machine and by the beeping of the EKG.
Ginger removed the Dacron graft from the steel tray, where it had been
soaking up blood and clotting precisely as desired.
She sewed the top of it into the aortal trunk, using an extremely fine
thread. Then, with the top of the graft sewn in place and the
unattached bottom clamped off, Ginger filled it with blood to let it
clot again.
Throughout these steps of the operation, it had not been necessary for
Ginger to have the sweat blotted from her forehead. She hoped that
George noticed her new dryness-she was sure he did.
Without needing to be told that it was once again time for music, the
circulating nurse reset the Bach tape.
Hours of work lay ahead of Ginger, but she pressed on without the least
weariness. She moved down the draped body, folding back the green
sheets,,revealing both of the patient's thighs. With the help of the
circulating nurse, Agatha had replenished the instrument tray and was
ready now with everything that Ginger needed to make two more incisions,
one in each of the patient's legs, below the inguineal creases, where
the legs attached to the body trunk. Clamping and tying off vessels,
Ginger eventually exposed and separated the remoral arteries. As with
the aorta before, she used thin elastic tubing and a variety of clamps
to valve off the blood flow through these vascular fields, then opened
both arteries where the bifurcated legs of the graft would attach to
them. A couple of times she caught herself humming along happily with
the music, and the ease with which she worked made it seem almost as if
she had been a surgeon in an earlier life, now reincarnated into the
elite brotherhood of the caduceus, predestined for this labor.
But she should have remembered her father and his aphorisms, the bits of
wisdom that he had collected and with which he had gently lectured or
patiently admonished her on those rare occasions when she had been less
than well behaved Or when she had failed to do her very best in school.
Time waits for no man; God helps those who help themselves; a penny
saved is a penny earned; resentment hurts only those who harbor it,-
judge not that ye be not judged.... He had a thousand of them, but
there was none he liked better and none he repeated more often than this
one: Pride goeth before a great fall.
She should have remembered those six words. The operation was going so
well, and she was so happy with her work,
so proud of her performance in this first major solo flight, that she
forgot about the inevitable great fall.
Returning to the opened abdomen, she unclamped the bottom of the Dacron
graft, flushed it out, then tunneled the twin legs of it beneath the
untouched flesh of the groin, beneath the inguineal creases, and into
the incisions she had made in the femoral arteries. She stitched in
both terminuses of the bifurcated graft, unclamped the restricted
vascular network, and watched with delight as the pulse returned to the
patched aorta. For twenty minutes, she searched for leaks and knitted
them up with fine, strong thread. For another five minutes, she watched
closely, in silence, as the graft throbbed like any normal, healthy
arterial vessel, without any sign of chronic seepage.
At last she said, "Time to close up."
"Beautifully done," George said.
Ginger was glad she was wearing a surgical mask, for beneath it her face
was stretched by a smile so broad that she must have looked like the
proverbial grinning idiot.
She closed the incisions in the patient's legs. She took the intestines
from the nurses, who were clearly exhausted and eager to relinquish the
retractors. She replaced the guts in the body and gently ran them once
again, searching for irregularities but finding none. The rest was
easy: laying fat and muscle back in place, closing up, layer by layer,
until the original incision was drawn shut with heavy black cord.
The anesthesiologist's nurse undraped Viola Fletcher's head.
The anesthesiologist untaped her eyes, turned off the anesthesia.
The circulating nurse cut Bach off in mid-passage.
Ginger looked at Mrs. Fletcher's face, pale now but not unusually
drawn. The mask of the respirator was still on her face, but she was
getting only an oxygen mixture.
The nurses backed away and skinned off their rubber gloves.
Viola Fletcher's eyelids fluttered, and she groaned.
"Mrs. Fletcher?" the anesthesiologist said loudly.
The patient did not respond.
"Viola?" Ginger said. "Can you hear me, Viola?"
The woman's eyes did not open, but though she was more asleep than
awake, her lips moved, and in a fuzzy voice she said, "Yes, Doctor."
Ginger accepted congratulations from the team and left the room with
George. As they stripped off their gloves, pulled off their masks, and
removed their caps, she felt as if she were filled with helium, in
danger of breaking loose of the bonds of gravity. But with each step
toward the scrub sinks in the surgical hall, she became less buoyant. A
tremendous exhaustion settled over her. Her neck and shoulders ached.
Her back was sore. Her legs were stiff, and her feet were tired.
"My God," she said, "I'm pooped!"
"You should be," George said. "You started at seventhirty, and it's
past the lunch hour. An aortal graft is damned debilitating."
"You feel this way when you've done one?"
"Of course."
"But it hit me so suddenly. In there, I felt great. I felt I could go
on for hours yet."
"In there," George said with evident affection and amusement, "you were
godlike, dueling with death and winning, and no god ever grows weary.
Godwork is too much fun to ever get weary of it."
At the sinks, they turned on the water, took off the surgical gowns
they'd worn over their hospital greens, and broke open packets of soap.
As Ginger began to wash her hands, she leaned wearily against the sink
and bent forward a bit, so she was looking straight down at the drain,
at the water swirling around the stainless-steel basin, at the bubbles
of soap whirling with the water, all of it funneling into the drain,
around and around and down into the drain, around and down, down and
down. . . . This time, the irrational fear struck and overwhelmed
her with even less warning than at Bernstein's Deli or in George's
office last Wednesday. In an instant her at-' tention had become
entirely focused upon the drain. which appeared to throb and grow wider
as if it were suddenly possessed of malignant life.
She dropped the soap and, with a bleat of terror, jumped back from the
sink, collided with Agatha Tandy, cried out again. She vaguely heard
George calling her name. But he was fading away in the manner of an
image on a motion picture screen, retreating into a mist, as if he were
part of a scene that was dissolving to a full-lens shot of steam or
clouds or fog, and he no longer seemed real. Agatha Tandy and the
hallway and the doors to the surgery were fading, too. Everything was
f
ading but the sink, which appeared to grow larger and more solid,
super-real. A sense of mortal danger settled over her. But it was just
an ordinary scrub sink, for God's sake, and she had to hold on to that
truth, clutch at the cliff of reality and resist the forces pulling her
over the edge. Just a sink. Just an ordinary drain. Just She ran.
From every side, the mist closed around her, and she lost all conscious
awareness of her actions.
The first thing she became aware of was the snow. Large white flakes
sifted past her face, gently turning, lazily eddying toward the ground
in the manner of fluffy airborne dandelion seeds, for there was no wind
to drive them. She raised her head, looked up beyond the towering walls
of the old highrise buildings that shouldered in around her, and saw a
she stared into the winter heavens, momentarily confused as to her
whereabouts and condition, her hair and eyebrows grew white. Flakes
melted on her face, but she slowly realized that her cheeks were already
wet with tears and that she was still weeping quietly.
Gradually, the cold impinged upon her. In spite of the absence of wind,
the air was sharp-toothed; it bit her cheeks, nipped her chin, and her
hands were numb from the cold venom of countless bites. The chill
penetrated her hospital greens, and she was shivering uncontrollably.
Next she became aware of the freezing concrete beneath her and the
ice-cold brick wall against her back. She was squeezed into a corner,
facing out, knees drawn up to her chin, arms locked around her legs-a
posture of defense and terror. Her body heat was being leeched away
through every contact point with pavement and masonry, but she did not
have the strength or will to get to her feet and go inside.
She remembered fixating upon the drain of the scrub sink. With
unmitigated despair, she recalled the mindless panic, her collision with
Agatha Tandy, the startled look on George Hannaby's face as he had
reacted to her screams. Although the rest was a blank, she supposed she
had then taken flight from imaginary dangers, like some madwoman, to the
shock of her colleagues-and to the certain destruction of her career.
She pressed harder against the brick wall, wishing that it would suck
away her body heat even faster.
She was sitting at the end of a wide alley, a blind serviceway that led
into the core of the hospital complex. To her left, double metal doors
led into the furnace room, and beyond those was the exit from the
emergency stairs.
Inevitably, she was reminded of her encounter with a mugger during her
internship at Columbia Presbyterian in New York. That night, he had
dragged her into an alleyway much like this. However, in the New York
alleyway, she had been in command, victorious-while here she was a
loser, descendant rather than ascendant, weak and lost. She perceived a
bleak irony and a frightening symmetry in having been brought to the
lowest point of her life in such a place as this.
Premed, medical school, the long hours and hardships of her intern year,
all the work and sacrifices, all the hopes and dreams had been for
nothing. At the last minute, with a surgical career almost within her
grasp, she had failed George, Anna, Jacob, and herself. She could no
longer deny the truth or ignore the obvious: Something was wrong with
her, something so desperately wrong that it would surely preclude the
resumption of a life in medicine. Psychosis? A brain tumor?
Perhaps an aneurysm in the brain?
The door to the emergency stairs was flung open with a rattle and a
screech of unoiled hinges, and George Hannaby came out into the snow,
breathing hard. He took several quick steps into the alley, heedless of
the risk posed by the quarterinch skin of slippery new snow. The sight
of her was sufficiently shocking to bring him to a lurching halt. A
ghastly expression lined his face, and Ginger supposed he was regretting
the extra time and attention and special guidance that he had given her.
He had thought she was especially bright and good and worthy, but now
she had proved him wrong. He had been so kind to her and so supportive
that her betrayal of his trust, although beyond her control, filled her
with self-loathing and brought more hot tears to her eyes.
"Ginger?" he said shakily. "Ginger, what's wrong?"
She was able to respond only with a wretched, involuntary sob.
Seen through her tears, he shimmered, blurred. She wished he'd go away
and leave her to stew in humiliation. Didn't he know how much worse it
was to have him staring at her while she was in this condition?
The snow was falling harder. Other people appeared in the doorway
through which he had come, but she could not identify them.
"Ginger, please talk to me," George said as he drew near. "What's wrong?
She bit her lip, tried to repress her tears, but instead she began to
sob harder than ever. In a thin, blubbery voice that sickened her with
proof of her own weakness, she said, "SSomething's wrong with me."
George stooped down in front of her. "What? What's wrong?"
"don't know."
She had always been able to handle any trouble that came her way,
unassisted. She was Ginger Weiss. She was different. She was a golden
girl. She didn't know how to ask for help of this kind, of this degree.
Still stooping in front of her, George said, "Whatever it is, we can
work it out. I know you're fiercely proud of your selfreliance. You
listening, kid? I've always stepped carefully when I'm with you because
I know you resent being helped along too much. You want to do it all
yourself. But this time you simply can't handle it alone, and you don't
have to. I'm here, and by God you're going to lean on me whether you
like it or not. You hear?"
"I ... I've ruined everything. I've (I-disappointed you."
He found a small smile. "Not you, dear girl. Not ever. Rita and I
have had all sons, but if we could've had a daughter, we would've hoped
for one like you. Exactly like you. You're a special woman, Dr. Weiss,
a dear and special woman. Disappoint me? Impossible. I would consider
it an honor and a pleasure if you would lean on me now, just as if you
were my daughter, and let me help you through this as if I were the
father you've lost."
He held out a hand to her.
She grasped it and held on tightly.
It was Monday, December 2.
Many weeks would pass before she learned that other people in other
places-all strangers to her-were living through eerie variations of her
own nightmare.
2.
Trenton, New Jersey
A few minutes before midnight, Jack Twist opened the door and left the
warehouse, stepping into the wind and sleet, and some guy was just
getting out of a gray Ford van at the foot of the nearest loading ramp.
The van's arrival had been masked by the rumble of a passing freight
train. The night was deep around the warehouse, except for four meager
patches of murky yellow light from poorly maintained, grime-dimmed
security lamps. Unfortunately, one of those lights was directly over
the door through which Jack had exited, and its sickly glow reached
precisely far enough to include the passenger's door of the van, out of
which the unexpected visitor had appeared.
The guy had a face made for police mug books: heavy jaw, a mouth that
was hardly more than a slash, a nose that had been broken a couple of
times, and hard little pig eyes. He was one of those obedient but
pitiless sadists that the mob employed as enforcers, a man who, in other
times, might have been a rape and pillage specialist in the armies of
Genghis Khan, a grinning Nazi thug, a torture master in one of Stalin's
death camps, or a Morlock from the future as imagined by H. G. Wells
in The Time Machine. To Jack, the guy looked like serious trouble.
They startled each other, and Jack did not immediately raise his .38 and
put a bullet in the bastard, which is what he should have done.
"Who the hell are you?" the Morlock asked. Then he saw the canvas bag
that Jack was dragging with his left hand and the lowered pistol in
Jack's right hand. His eyebrows shot up, and he shouted, "Max!,,
Max was probably the driver of the van, but Jack did not wait around for
formal introductions. He did a quick reverse into the warehouse,
slammed the door shut, and stepped to the side of it in case someone out
there started using it for target practice.