The victim of the motorcycle accident, Dolores, had been dispatched to radiology for a scan of her femur, so Millard crossed the seventh-floor walkway to the VIP unit. Along the way, he exchanged waves and hellos with half a dozen colleagues, including Saul Duransky and Art Rosenstein, the latter rolling his left foot in a traction boot; the charge nurse from the pulmonary care center, who’d been a nursing student during Millard’s own internship, gave him a hug; one of the housekeepers from the Luxdorfer Pavilion, where he’d once had an office, greeted him by name. What a good feeling it was to be known someplace, to have been part of something in this way. Not that he considered himself irreplaceable—he wasn’t foolish enough to believe that. Everybody was expendable. Presidents, kings. When the pope died, they found a new pope. Fools and narcissists forgot that at their peril, as, over the years, had several of Millard’s bosses. So no, he wasn’t irreplaceable, but he was well-liked, and he was grateful for it. Reflecting on his encounter with Dennmeyer, Millard found himself grinning, almost giddy.
In nearly five decades at St. Dymphna’s, Millard had encountered his fair share of celebrity patients: politicians, performers, a retired five-star general. As a fourth-year resident, he’d sat up late one evening with a dying Tallulah Bankhead; during his first months on the faculty, he’d prescribed a sleeping aid for Charles Lindbergh after the aviator’s appendectomy. Back then, the VIP unit had been located across Madison Avenue, on the top floor of the Hapsworth Annex, affording critically ill power brokers a 270-degree view of Manhattan. The titans of entertainment and industry had since been ousted from this perch by hospital executives, who’d appropriated the penthouse for office space, but the new VIP digs, overlooking Central Park, proved none too shabby. In the spacious entryway, furnished with damask wingback chairs and a baby grand piano, a glass-encased waterfall tangoed under kaleidoscopic lights. At four o’clock every afternoon, white-gloved orderlies served high tea in the visitors’ lounge. The most striking contrast between 7-West, as the unit was known, and the rest of the hospital, was its stunning silence. Yet the floor also harbored a secret, known only to senior clinicians: When compared with the treatment provided elsewhere in the hospital, the medical care itself was substandard. No amount of complimentary scented bathing gel or gourmet Equatoguinean chocolate compensated for the benefits of having medical students and junior residents and nursing trainees bustling through one’s room, always on the lookout for an errant tube or a wrongly hung bag of electrolytes. Lives had been saved, many times over, by the fresh-eyed neophyte asking, in complete innocence, “Why are we giving that medicine to this patient?”
Millard encountered Lucius Jeffers as he had left him. The currency guru relaxed on the sofa, lanky limbs splayed like branches, watching the stock ticker scroll across his plasma TV. Mrs. Jeffers lay on her stomach atop the patient’s bed, reading an airport novel, her stockinged feet a pair of scissor blades. She was a pleasant, soft-spoken woman in her forties. Not unattractive, but certainly not a former fashion model. They had a daughter at Vassar, Millard vaguely recalled—or possibly Bryn Mawr. Name the Seven Sister schools, he mused: now that was a good challenge for the medical students. At one time, he’d been a frequent visitor to several of these diminished institutions, including Barnard, when he’d dated a botany major, and Wellesley, Carol’s alma mater, where he’d grown intimately familiar with the shadowy pull-off behind a nearby country club. Back in the days when you could get an Ivy League education at a women’s college. Long time ago.
Over the years, Millard had discovered that the wives of the terminally ill—which Jeffers likely was, despite the absence of a formal diagnosis—fit into one of two factions. In a first group clustered the loyal victims: women who never left their husbands’ bedsides, transforming overnight from homemakers or schoolteachers or retired librarians into devoted nursing assistants whose lives revolved around applesauce feedings and sponge baths. He could picture Isabelle as one of these votaries, stoic with forced cheer, singing him lullabies in his dementia. Carol also fit this mold—although one could more easily imagine her bullying house officers than reading bedtime stories. So did Mrs. Jeffers. At the opposite extreme were the fair-weather mates, often younger women on their second or third marriage, who dropped their moribund husbands off at the hospital like so much soiled bed linen and vanished into the ether. As one wife had said to Millard, when he finally reached her by phone, “I love my husband, Doctor, but I didn’t sign up for this.” Millard wondered whether, had circumstances proven different, Delilah would have camped out in his hospital room or fled into the night. He honestly didn’t know.
“Look who’s here,” said Mrs. Jeffers. “It’s Dr. Salter. The psychiatrist.”
Jeffers looked up. He had a towel draped over one knee, as though at a sauna.
“Good morning, Lucius,” Millard said. “Do you remember me?”
“Of course, he does,” interjected Mrs. Jeffers. “Don’t you, honey?”
Millard threw her a silencing look. He pulled up a chair alongside her husband.
“Do you remember who I am?” Millard asked again.
Jeffers nodded. “Sure. You’re the fellow from that place.” He grinned, tapping his thigh methodically. “I’m so glad you’re here.”
“What kind of building is this, Lucius?”
Millard’s question educed a benighted shrug. “This . . . this is a . . . you know,” said Jeffers. “Anyway, I’m glad you’re here. I was just saying we should strike a stake in the Brazilian real. Latin America is where it’s at. Not China. Not India. Have you been following the Paraguayan guarani and the Uruguayan . . . and the Uruguayan you know . . . ?”
Millard waited for a break in Jeffers’s rambling.
“I have to ask you a few basic questions,” he said. “I want you to tell me where we are. Is this a bank? A library? Or a hospital?”
Jeffers frowned, irked. Millard glanced at Mrs. Jeffers, his eyes warning her not to assist.
An uncomfortable pause followed, punctuated by the low murmur of the financial news rumbling from the television console. Then Jeffers pounded his fist on the cushions without warning and snapped, “A bank, dammit. Do you think I’m stupid?”
Confabulation was one of the symptoms of the financier’s dementia. A costly battery of tests—MRIs, LPs, EEGs, PET and SPECT scans—had revealed no explanation for his sudden decline; next on the agenda would be a brain biopsy. Not that the results particularly mattered: Anything they discovered at this stage in the dismal game was probably irreversible.
“Nobody thinks you’re stupid, Lucius,” soothed Millard. “I have to ask everyone these questions. It’s a formality.”
Millard thanked Jeffers for his time; he was about to promise to visit again the following morning, but he checked himself—no need to deceive gratuitously. What he really wished to do was to return to the afflicted man’s room after lunch, while Mrs. Jeffers was running an errand, and to serve him a lethal injection of potassium chloride. In his fantasy, Millard imagined wandering from ward to ward all afternoon, euthanizing the tortured, senile casks of flesh who lacked the power to terminate their own indignities. He doubted the authorities would catch him before he offed himself—not if he operated with stealth, choosing only the most severe cases. By the time the coroner unraveled the etiology of this daylong epidemic—the “Millard Salter Massacre”—he’d be playing shuffleboard and canasta on a cloud with his so-called victims, or toasting crisply in Hades. Needless to say, Millard knew that he would do no such thing, that after five decades saving lives—at least, to the degree a headshrinker could claim to save lives—he did not have inside him whatever je ne sais quoi was required to kill strangers, not even with impunity, not even if justice and morality linked arm in arm at his side. Helping Delilah die with a mite of self-respect was a deed that strained at the far reaches of his moral tether.
Mrs. Jeffers escorted him to the door. “Not his best day,” she said, almost apologetic.
“He seems comfortable,” replied Millard. “That’s important.”
They stood face-to-face in the dim vestibule. The man you love is dying, thought Millard, and the woman I love is dying, yet we’re each trapped in our separate hells.
“Any news?” she asked.
“Not yet,” said Millard. “We’ll hope the biopsy shows something.”
He offered her a few additional words of solace and ducked into the corridor, grateful to have escaped without confessing his own secret.
A young girl, unchaperoned, had commandeered the piano. The child was decked out in a white taffeta dress, overlain with tulle, as though truant from a first communion; an indigo bow in her butterscotch ponytail offset the pallor of her long, bare arms. What a pleasure, reflected Millard, to see someone—even a child—dressed up to make a sick call for a change. How recently, it seemed, that one had been expected to don a necktie, or at least a sweater and slacks, when traveling by airplane or dining out; now middle-aged men wore dungarees to the opera. He watched the child perform with admiration. Her fingers danced across the keys, filling the forecourt with a perfectly respectable, if uninspired, rendition of Liszt’s second Hungarian Rhapsody. At the height of the friska—that moment where Liszt leads his listeners into the eye of the hurricane, as the key shifts from F-sharp minor to the cadenza—the music halted abruptly. The girl had caught sight of her parents regarding her from the far end of the plaza.
Millard nodded at the couple. With his rumpled white coat and his stethoscope draped over his shoulders, he looked avuncular, grandfatherly—not threatening. And what a crazy world he’d be leaving, where, without these accoutrements, a seventy-five-year-old widower, pausing to admire a child’s piano performance, might be mistaken for a pervert.
The girl’s mother clapped softly, urging the girl to continue, but the child refused and dashed across the atrium for a hug. For many, the great miracle of life was parenting—childbirth, the transformation of a helpless infant into an autonomous adult—but for Millard, who’d found fatherhood meaningful, but not particularly magical, the great marvel occurred earlier, in the pairing off of unsuspecting young men and women. Or, these days, men with men and women with women, which was just as improbable and miraculous. Parenting, after all, had a logical, almost inexorable drive: conception, pregnancy, labor, nursing—and then cowboys and princesses, bar mitzvahs and communions and sweet sixteens, college visits to Cambridge and New Haven. But romance! One could be casual acquaintances for twenty years, as he’d been with Isabelle, and then a single, brief conversation in an elevator—about Leontyne Price, of all people—could lead you down a path of loaning cassette tapes and making love in vacant call rooms. Or one could be casual acquaintances for twenty years, and chat about Leontyne Price, and never experience some embryonic spark that sent one down the road to fusion. Why Isabelle? Why Carol before her? And why Delilah now? Why these women and not that leggy, fern-obsessed coed from Barnard whom he’d dated before Carol, or Art Rosenstein’s widowed sister-in-law, who’d been nominated for a Tony Award in the ’70s? Or doe-eyed, coquettish Lettie Moshewitz, who’d taken a mortar to his heart at age twelve? Yes, that mutuality was the true miracle. Millard watched as the young girl buried her head in her mother’s skirt; her father stood by, momentarily superfluous, exchanging a troubled glance with his wife. From the sorrow on the man’s face—he couldn’t have been more than thirty himself—Millard sensed that the sick call had not gone well, that soon the junior musician would be wearing black crêpe.
What an old man I’ve become, he scolded. Lost in other people’s business.
He turned toward the elevator bay and nearly toppled the young woman behind him.
“I’m sorry, Dr. Salter . . . ,” she stammered. “I didn’t want to interrupt.”
“I’m the one who should be sorry. Not looking where I’m going. I am becoming one of those dotty old men, walking into walls . . . .” He inched backward, keeping a suitable distance between himself and the busty brunette. “But you really do have to call me Millard. One of these days, you’re going to be an attending yourself—and then it’s going to be awkward to change, so we might as well start off on a first-name basis . . . .”
He had been urging the medical students to call him Millard for nearly forty-five years, and had gained absolutely no traction. Of course, Lauren Pastarnack—his eyes darted across her ID badge to confirm her name—would be deprived of the opportunity that he’d promised. By the time she graduated to the rank of attending physician, he would be nothing more than “that psychiatrist who hanged himself, the old guy,” if he were lucky, or possibly his name would merely elicit blank stares. No matter. In any case, Millard felt fondly toward the young woman; she had rotated through his service the previous autumn, during her third year, and had conducted herself admirably. The girl had proven a tad naïve—a delusional patient had convinced her that he’d trained as a commercial airplane pilot—but, at her age, that was probably far better than being prematurely jaded and cynical.
“I’m not sure if you remember me,” she began.
“Of course, I remember you. Lauren Pastarnack. You took care of that aviator . . . .”
Pastarnack blushed. Immediately, Millard regretted his remark.
“I’m just pulling your leg,” he said quickly. “You did a fine job on our team.”
Her face colored even further. “Thank you, Dr. Salter. I mean Millard.” She shifted her weight from one foot to the other, her shapely, stockinged calves exposed below her skirt. Millard did not feel desire. Whatever lust he’d once had for women in their twenties had evaporated long ago. Yet he’d retained the self-consciousness that comes with fearing that others might still suspect him of desire, so he looked away. The butterscotch-haired prodigy and her parents sat ensconced at the far side of the atrium, conferring in hushed tones; both father and daughter appeared tearful. “I’ve been meaning to stop by your office,” said Pastarnack.
“Have you now?”
“I was kind of wondering if you might feel comfortable writing me a letter of recommendation?” she asked. “I’m going to apply for a residency in psychiatry—and I think I did some of my best work on the consult service . . . .”
Now the girl looked away. What a crazy system, reflected Millard, that compelled a strikingly intelligent young woman—she’d graduated from Stanford, he recalled—to approach a fossilized fool like himself as a supplicant. He did not wish to disappoint her; at the same time, his day was already packed solid—and he wasn’t sure he wanted to spend his final free moments attempting to fit letterhead into his printer. If only she had asked a week earlier. The logical thing—the path of least resistance—was to steer her to Stan Laguna for the letter. But the difference between his imprimatur and his junior colleague’s might mean the difference between remaining at St. Dymphna’s and ending up at a community hospital in Milwaukee.
“If you don’t think you can . . .” stammered the girl.
“What are you doing right now?” asked Millard.
“Nothing . . . . Studying for boards, I guess . . . .”
“Walk with me. I’m on my way to see a patient.”
They passed through the steel fire doors and climbed the stairs to the ninth story. Millard had a rule against taking the elevator for fewer than three flights up or four flights down while rounding, a principle he’d held to even after losing cartilage in his knee—although accruing the benefits of an additional five minutes of exercise seemed absurd under the circumstances. But if he didn’t need the workout anymore, at least he was setting an example. And saving energy, which on a scorching summer day might prove his last service to the commonweal.
“How is your studying going?” he inquired.
“I guess I’ll find out in three weeks. There’s so much to learn.”
And most of it thoroughly useless, thought Millard: the chromosomal positions of various gene loci, the patterns of trinucleotide repeat disorders, the symptoms of enzyme deficiency syndromes one would never encounter in practice. “I have a question for you,” he said. “In the 1920s, there were two acceptable treatments for an acute myocardial infarction in New York City. Do you know what they were?”
“Aspirin?”
“Not in the 1920s. The belief back then was that aspirin weakened the heart . . . .”
They paused opposite the orthopedics unit. Pillars of sun beamed through the rectangular skylights, dappling the carpet. Millard could sense the gears of gray matter churning behind the girl’s vast hazel eyes. “What cured everything a hundred years ago?”
“Chicken soup,” guessed Pastarnack.
Millard grinned. At least she was thinking, and thinking outside the box. He wished Lysander had found himself a girlfriend like Lauren Pastarnack.
“Bed rest,” said Millard. “At the exalted St. Dymphna’s Hospital, they treated a heart attack with six months of bed rest.”
The girl smiled up at him. He wondered if he were boring her.
“On the other side of Manhattan, a pioneering Hopkins-trained cardiologist, John Davin, adopted a different approach. This was at the height of Prohibition, and Dr. Davin’s cure for heart disease was a daily stein of beer.”
“Beer?”
“Indeed, beer. He did a land-office business, I’m sure, doling out prescriptions. Now I want you to use your extensive medical knowledge and tell me which worked better—bed rest or beer?”
“The answer has got to be beer,” said Pastarnack. “Or you wouldn’t be asking me. But I don’t know why . . . . Is there a microbe in beer that dissolves blood clots?”
“Is there a microbe in beer that dissolves blood clots?” echoed Millard. “Do we still prescribe beer for heart disease? We may have sold our souls to Merck and Pfizer, but not to Budweiser. Not yet.” He paused to let his wisdom, or at least his wit, settle in. “Beer, I’m afraid, has absolutely zero effect on clogged arteries. Dr. Davin’s patients ended up no better off than before they took up drinking—at least, from a cardiologic standpoint.”
“So bed rest is better?” Pastarnack asked.
“Heavens, no! Beer is neutral. Bed rest is fatal.” Millard heard the pedantry in his voice—but at seventy-five, wasn’t he entitled to wax a smidgeon pedantic? “Imagine all of those patients lying in bed for months at a time, without anticoagulation, without aspirin, clotting up their arteries, developing deep vein thromboses, when what the situation called for was a spirited walk around the block . . . . The exalted St. Dymphna’s Hospital and its competitors killed tens of thousands of people. A man suffered a mild heart attack—and then took to bed, and died of a major coronary event or a stroke a few weeks later. Clark Gable. John Steinbeck. Bed rest nearly killed President Eisenhower. You have heard of President Eisenhower, haven’t you?”
“He built the highways,” chirped Pastarnack. “I still remember something from high school history.”
“Yes,” conceded Millard. “He built the highways.”
But why should this girl know about Ike? What did he have to say about Calvin Coolidge or Grover Cleveland?
“You hear a lot about ‘the days of the giants’ in internal medicine,” observed Millard. “Back in that golden age when residents worked ninety-six hour shifts and performed lumbar punctures on two different patients simultaneously.” Even during his own training, there had been legacies of giants one could never venerate sufficiently or manage to slay—Halsted, Osler; men who towered over the profession like soldiers in the memories of war brides. “Claptrap. Romanticized bunk. I lived through the era of the giants, and I can tell you, as an eyewitness, that those so-called giants slaughtered lots of innocent people. I’d gladly throw in my lot with today’s pygmies.”
Millard stopped himself, mid-diatribe. “Pygmies” was the sort of slip that could land one in the doghouse with the associate dean. “The good news,” he said, “is that there won’t be any questions about the therapeutic qualities of beer on your exam.”
“One fewer thing to study,” said Pastarnack.
Now he was certain that he was boring her. She’d have worn the same smile while listening to him read the telephone directory like a senator conducting a filibuster; anything for a recommendation. He still recalled the humbling process of requesting his own letters half a century earlier—accompanying one self-absorbed clinician to the sauna, helping another carve gourds into bird feeders on his suburban patio. While he doubted this young woman would join him in the sauna or the steam room, he was confident that he could have her sculpting gourds with little effort.
“I have to look in on a patient—just for a moment,” he said. “Will you come with me? Then we can talk about your letter.” Assuming she’d agree, he added, “It’s a case of what we used to call reactive depression. Exogenous depression. Poor woman was riding her motorcycle when a fire truck came through an intersection. She miscarried and lost her leg.”
“That’s got to be the saddest thing I’ve ever heard,” said Pastarnack.
You dear, innocent child, thought Millard. You don’t know what’s ahead of you.
He said nothing of the asylum seekers he occasionally treated for free in St. Dymphna’s torture clinic, nothing of his days on the AIDS ward during the 1980s. He could have told her about the homeless grandmother set afire by the marauding teens, about the Pakistani illustrator blinded with lye. He didn’t even point out that, in his passé, admittedly chauvinistic opinion, women who were nine months pregnant had no business riding motorcycles.
“You’ll hear sadder,” he said, matter-of-fact.
They paused at the nursing station long enough for Millard to greet the clerk and scan the room assignments on the monitor. Patients had a knack for shifting locations during the overnight—like infantry strategically repositioned for battle. Every junior clinician had experienced the sinking terror, the sense of depth charges detonating inside one’s abdomen, when one entered the room of a young, relatively healthy patient, for an early morning physical, to find the bed bare, the linens crisp and unsullied. More often than not, this tragedy resulted from staffing logistics, not death or disease, with the perpetrator of the atrocity carrying a clipboard rather than a scythe, and the victim merely relocated across a corridor or up a flight of stairs. Dolores, it turned out, had been so moved. An MRI of a femur lasted long enough to banish a person as far as an entirely different unit, so they were fortunate to find her only two doors down from the room she’d previously occupied. She looked uncomfortable, almost contorted, tilted slightly to her side and propped at a sixty-degree angle, a turquoise scarf wrapped around her scalp. In a nearby chair, portly as a walrus, basked her torpid minder.
The suicide minder’s job was to sound an alarm if Dolores attempted to harm herself in the hospital, but she looked as though she might just as easily doze through the event. Their entrance was her cue to visit the restroom.
“Good morning, Miss Noguerra,” said Millard.
Dolores gawped back at him indifferently, her affect as blunt as a pewter plate.
He leaned against the radiator and lowered his voice. “I’ve brought one of my students with me this morning,” he said. “We wanted to see how you’re doing.”
“The same,” said Dolores. Monotone. Her blankets had shifted over the edge of the bed, revealing her bandaged stump. An ugly scar crossed her remaining ankle. “May I?” asked Lauren Pastarnack—and with the delicate alacrity of a skilled nurse, she re-draped the covers. Dolores grimaced, but said nothing.
“Yesterday, you expressed that you were having some concerning thoughts,” observed Millard. “About hurting yourself. Are you still feeling that way?”
The patient shook her head—a whispered gesture.
“Please take her away,” said Dolores. “She breathes too loud.”
For a moment, Millard thought she meant Pastarnack, but then he registered that she’d been referring to the suicide minder. “Are you sure you’ll be safe without her?”
“She breathes too loud and her stomach growls,” said Dolores. “I swear she’s going to drive me over the edge . . . .”
Millard had little doubt that the minder did breathe too loudly. And over the years, he’d come to the realization that if someone was determined to kill herself, there wasn’t much a physician—or anybody else, for that matter—could do about it. You might prevent a person from taking her life this morning, or this weekend, but not next month or next year. “How does this sound? Why don’t we keep you under observation for one more day—to err on the side of caution?” he proposed. “And if you’re still feeling safe tomorrow, we’ll cancel the one-to-one . . . .”
Dolores closed her eyes, shutting him out. The truth was that he didn’t really suspect she’d harm herself—and if she did, who could say that wasn’t a reasonable decision for a thirty-one- year-old woman who’d lost a leg and a baby? Yet even on his final workday, Millard found himself unable to call off the minder prematurely. Maybe it was instinct, a habit so ingrained that it mimicked a reflex—like his late brother’s aversion to crustaceans. They’d been raised kosher, and although both of them had drifted from organized Judaism, Lester had never been able to stomach a lobster or a shrimp cocktail. “How can I?” he’d once asked Millard. “It’s the curse of upbringing. You might as well ask me to drink human blood.” Millard, who’d grown to savor bay scallops and cheeseburgers, had suffered no such atavistic compunction.
“I’ll have Dr. Laguna stop by tomorrow to check up on you,” said Millard. “He’s a very good doctor. I think you’ll like him.”
Dolores rolled farther onto her flank. Millard waited for the minder to return from the restroom before departing. The endomorphic woman did indeed gasp as she waddled—like a pregnant basset hound on a summer afternoon—but what could be done? You couldn’t exactly instruct the woman to stop breathing. He was glad to return to the corridor, which smelled vaguely of antiseptic. Nearby, a stoop-shouldered fellow buffed the floors, humming Irving Berlin’s “This Is the Army, Mr. Jones.” Now there was a tune you didn’t hear every day! Millard steered Pastarnack past a phalanx of meal carts fortified with discarded breakfast trays, grateful to leave the unit. He didn’t say a word until they’d reached the ninth-floor courtyard, where a frangipani tree rose implausibly amid the wrought iron tables and benches. One of his self-imposed rules was that, whenever possible, he never discussed a patient while still on the unit, much as one didn’t conduct a postmortem of the opera within a ten-block radius of the performance. Who could say that the mezzo-soprano’s mousy sister from Des Moines wasn’t ambling behind you in that ragged pea coat? No need to wound feelings unnecessarily.
“So what do you think?” asked Millard. “Should we let her kill herself?”
His provocation failed to fluster Pastarnack. “Absolutely not. She’s visibly depressed . . . .”
“But her depression could be perfectly rational. Maybe you don’t know the whole story. I didn’t tell you that she was a professional marathon runner, did I? Or that her husband was killed in the accident. Or that she can’t have any more kids. She’s lost her career, her family—who wouldn’t be depressed under the circumstances?”
Flames surged into Pastarnack’s pale cheeks. “I’m not saying her depression isn’t rational—or a valid response to her suffering—only that it’s not permanent.”
“How do you know?”
“I don’t. Not for sure. But there are no guarantees for anything in medicine. We don’t know for sure that bypass surgery or a Whipple procedure will succeed, yet we still perform them. Let her try an antidepressant. Or shock therapy.”
“Shock therapy won’t win her the Boston Marathon.”
“There’s always the Paralympics. Or she could be a leading advocate for the disabled. Would you have let Helen Keller kill herself?”
“And what if shock therapy fails? What if fifteen years go by and you’re the head of the consult service and she’s still sitting in that room?”
“We’ll deal with that when it happens,” rejoined Pastarnack. She spoke forcefully, free from her shell of deference. “I see what you’re driving at. And yes, maybe there is a place for rational suicide if you’ve been depressed for fifteen years and failed all interventions—but that doesn’t mean every sixteen-year-old girl whose boyfriend breaks up with her should be allowed to overdose on Tylenol.”
Now Dolores Noguerra wasn’t exactly a rejected teenager . . . .
Pastarnack’s intensity surprised him. He feared he’d touched a live wire: Maybe she had a parent or sibling who’d succumbed to despair. Yet he was delighted that she’d put up an argument—even if he was no longer certain that she possessed the better part of it.
“Okay, you win,” he said. “We won’t let her kill herself just yet.” Many of Millard’s colleagues shared the girl’s caution when it came to so-called rational suicide. Outcomes after trauma proved consistently hard to predict. Some people endured the Bataan Death March, or a failed escape from Sobibór, or seven years as “guests” of Ho Chi Minh in the Hanoi Hilton—and survived psychologically unscathed, able to embrace joy like Elie Wiesel and practice forgiveness like Nelson Mandela. Others found themselves crippled for life by minor setbacks—a nonviolent mugging, a fender-bender, a lost passport. His own mother had once taken to bed for weeks after misplacing her evening gloves. “Let’s at least give her natural resilience a chance to kick in.”
He afforded Pastarnack a moment to savor her victory before revealing his artifice. “For the record, Miss Noguerra wasn’t a marathon runner,” he said. “She’s a special ed teacher. With a devoted boyfriend, I might add, who has never been hit by a fire truck—at least, as far as I know. And there’s no reason to think she can’t have as many children as she’d like . . . .”
Now that flummoxed the girl. “So you made that all up?”
“I wanted to see how strongly you’d defend your case—and I give you a lot of credit. If psychiatry doesn’t work out, there’s always law school.”
At once, like a punctured Bobo doll, the cheer slackened from Pastarnack’s face.
“That was a joke,” said Millard. “So where were we? That’s right, we were discussing your letter of recommendation . . . .”
“I can write the first draft myself, if that’s helpful,” offered the girl.
She hadn’t meant to be impertinent, he knew. Many of his colleagues had embraced this shortcut. To Millard, the idea exemplified lunacy—like having criminal defendants serve as their own jurors. “That won’t be necessary,” he said. “But I do want to get a sense of your knowledge base if I’m going to write you a letter. Do you think you’re up to answering a few more questions? Nothing about beer, I promise.”
Pastarnack’s entire body, without moving, seemed to uncoil like a spring. Answering questions was what she’d been trained to do all of her life. “Sure,” she agreed.
What choice did she have? He wouldn’t have held a refusal against her, at least consciously, but she had no way of knowing that.
“First question,” said Millard, channeling his internal game-show host. “Can you name the Seven Sisters?”
A look of bewilderment took hold of the girl’s delicate features. “I’m sorry, Dr. Salter. I’m not sure what you’re asking. Do you mean from Walt Disney?”
Brilliant! She thought they were cartoon characters, maybe the brides of the Seven Dwarfs. He recalled there’d been a soppy musical, Seven Brides for Seven Brothers starring Howard Keel and Jane Powell, but he didn’t think that was Disney—and anyway, if she knew nothing of Eisenhower, she probably also didn’t watch obscure films from the ’50s.
“Let’s try again. I imagine you’re familiar with all eight Ivy League schools,” said Millard. He ticked them off on his fingers: “Harvard, Yale, Princeton, Brown, Columbia, Cornell, Dartmouth, and the University of Pennsylvania.”
Pastarnack nodded, wary.
“My challenge for you is to name the Seven Sister schools—the Women’s Ivies, if you will. I’ll give you a hint to start. You might be tempted to guess Pembroke, because it was affiliated with Brown, but Pembroke was not a Seven Sister.”
The young woman eyed him as though he’d walked off the moon. Clearly, Pembroke had not been on the tip of her tongue. “I really have no idea,” she stammered.
“You were expecting a question about neurotransmitters, I suppose.” He’d tried to sound sympathetic, but feared he had come across as smug. “Give it the old college try . . . . You must know some all-girls schools . . . .”
“I don’t know . . . . Barnard?”
“Very good. That’s one.”
“And the one in Massachusetts. That Hillary Clinton went to. Mount Holyoke?”
“Kind of. Mount Holyoke is one of them, but Mrs. Clinton went to Wellesley, which is also a Seven Sister,” replied Millard. “I’m feeling generous, so I’ll give you credit for both. Four to go.”
Lauren Pastarnack’s lips pursed, but she shook her head.
“I’m sorry. I just don’t know.”
“Very well. Three out of seven isn’t so dreadful. If you were a baseball player, you’d make the Hall of Fame. Ready for your next question?”
“I guess.”
“What field did Jimmy Durante make major contributions to?”
Again, the girl’s expression faltered. He recalled the first puppy he and Carol had adopted for Lysander, a dopey schnauzer, his eyes beset with perpetual dejection. Of course, the girl’s gloom was entirely his own fault. Seconds passed, each moment like a boulder struggling to squeeze through the throat of an hourglass. “Do not squander time, Dr. Pastarnack,” he warned. “It is the stuff from which life is made.”
“If I had to choose, I’d say pharmacology.”
“In a way,” Millard said. “To the degree that pharmacology is a form of stand-up comedy.”
He glanced at his wristwatch. What compulsion kept him tormenting this gifted young woman, when he ought to be consoling Rabbi Steinmetz, was impossible to articulate. “A final question, Dr. Pastarnack?”
Now the girl merely looked at him with incredulity.
“Who composed the song ‘This Is the Army, Mr. Jones’?”
Millard realized that a bystander might interpret this quiz as a manifestation of sadism, but he suddenly understood that his motives were actually masochistic: He was reminding himself how obsolete he’d become, how irrelevant his knowledge was to a woman in the prime of life. Yet his victim couldn’t be aware of that. Anguish stewed in the girl’s limpid eyes and Millard’s face flushed with shame.
“These questions aren’t fair,” said Pastarnack—timorously, as much an appeal as a statement. “Honestly, I was expecting questions about neurotransmitters. Or, at least, medicine . . . .”
So she’d called his bluff. Kudos to the kid. “Of course, they’re not fair,” he agreed. “I was waiting to see how long it would take you to say something . . . .”
“Oh.”
“If you see something that doesn’t make sense to you in the hospital, there’s a good chance it doesn’t make sense to anyone else either—only they’re all afraid to express anything. You could save somebody’s life by saying, ‘This isn’t fair’ or ‘That’s unreasonable.’ ”
“Wow. I thought you were being serious . . . .”
Millard beamed, pleased with himself. This was likely to be the last lesson he ever taught, even unwittingly, so he was delighted that it had gone so well. But writing the girl a recommendation, no matter how talented she might be, would require time, time that he didn’t possess. And yet, the notion of her talents being squandered at a community hospital in Milwaukee, or wherever, genuinely pained him. Not that there was anything wrong with Milwaukee—if you were looking to open a brewery or locate a television sitcom.
“Now about that letter of yours,” he said. “I’ll make you a deal. I’m going to be out of town for a while, but if you send me the link to upload your recommendation today, I’ll do it before I leave . . . .”
She actually clapped her hands together at first—like seal flippers—then clasped them in front of her as though he’d answered a prayer.
“Thank you, Dr. Salter—Millard—Millard Salter,” she spluttered.
“But make sure you get the link to me by five o’clock.”
“I’ll do it right now,” she promised.
“And in case you’re wondering, Irving Berlin composed ‘This Is the Army, Mr. Jones.’ ”
“I won’t forget that.”
As though she had any notion who Irving Berlin might be.
“Now I have patients to see,” he added, “and you have lynxes to avoid.”
She looked at him puzzled again, eyebrows raised in doubt, so he pointed to the flyer on a nearby pillar, styled like a wanted poster out of the Wild West in carnival font with sepia lettering: ESCAPED LYNX CUB. “You’re not joking,” she said, surprised.
“Occasionally, I do say something serious,” he replied. “For variety. Now please go send me that link before I forget who you are . . . .”
The girl thanked him again and vanished into the elevator. He strolled in the opposite direction, toward the bone marrow unit, where Rabbi Steinmetz lay imprisoned in an immunological bubble. Steinmetz would likely be his final patient (ever!), and at the rate the clergyman’s fever had progressed, he might prove Steinmetz’s final doctor. Lost in his reverie, Millard suddenly realized that he was humming—“This Is the Army, Mr. Jones”—and he checked himself abruptly.
He retrieved disposable gloves and a mask from a cart beside the rabbi’s door. Inside, he found Ezra Steinmetz seated at the window, alone, gazing down at the traffic below. The young chaplain—he was closer in age to Maia than to Lysander—wore a cozy royal purple robe with a shawl collar; the Post’s sports pages lay scattered across the tangled sheets. On the bedside table, the checkers board from their Friday morning match stood intact, men and kings standing in scattered ranks as though arrested by a neutron bomb. Steinmetz flashed Millard a smile, but his visage quickly retreated back to a look of fatalistic despair.
“How are you?” asked Millard.
“Honestly, scared scriptless, as they say. I think I’ve run out of words.”
“You don’t have to talk.”
Millard had brought along the checkers board the previous week; in his experience, tangible challenges like checkers or chess provided a soothing alternative to reflection. Half of his job, he’d once said to Isabelle, entailed throwing sets of backgammon.
“I don’t mind talking,” said Steinmetz. “I just don’t think there are words to express how I feel. Reality is kicking in. I’m going to die.”
“Are the doctors saying that?” asked Millard. “Or are you saying that?”
“The doctors are saying that I’ve got a good chance of pulling through. They’re oncologists—they always say that. They’ll be saying that at my funeral . . . . ‘If only we give him one more round of chemo . . . .’ ” Steinmetz smiled at his own macabre humor, but his lips quickly flatlined. “I try to sound optimistic, for the sake of Janice and the girls, but I can read the writing on the wall. My goose is cooked.”
“You’ll outlive me yet,” said Millard.
“No, I won’t.” The rabbi rose from his chair with considerable effort and shuffled to the bed. He poured a few sips of club soda from a miniature bottle into a plastic cup and swallowed, his Adam’s apple stark against his skeletal throat. Only once the rabbi had settled onto the bed, frail as a relic on a concrete slab, did Millard realize that he’d done this act selflessly, to vacate a seat for his guest.
“There’s nothing special about dying,” said Steinmetz. “It’s one of those few universals. Even dying at thirty isn’t so unusual. I keep thinking of those lines from Ecclesiastes: A living dog is better than a dead lion, for the living know that they will perish, but the dead know nothing . . . . Nevermore will they have a share in anything done under the sun . . . .” The rabbi wiped the crook of his eye, rapidly, as though hoping not to be seen. “I thought I’d be at peace—and I’m not. I’m scared, Doc. I didn’t expect to be scared, but I’m terrified.”
“Of anything specific?” asked Millard.
Steinmetz shook his head. “That’s just it. I can’t even articulate what I’m afraid of. Not of pain—that’s well-controlled . . . and even if it weren’t, pain is merely pain. And Janice and the girls will be provided for. Her father’s quite well off, you know.” The rabbi adjusted his pillows beneath his corroded spine. “The closest that I can get to what I’m afraid of is some nebulous uncertainty—not the unknown, not the afterlife, not the olam ha-ba, if there even is one—just an aching feeling of insecurity. Does that make any sense?”
“As much sense as anything.”
“In the Book of Job, we are told, So man lies down, and rises not: till the heavens be no more, he shall not awake, nor be raised out of his sleep . . . . What happens after that, of course, has kept sages far wiser than myself awake at night for many centuries . . . .”
Millard listened as the rabbi quoted various Biblical passages. The only one he recognized came from the 146th Psalm: “Do not put your trust in princes, in human beings, who cannot save. When their spirit departs, they return to the earth; on that very day their plans come to nothing . . . .” What puzzled Millard wasn’t Steinmetz’s fear—that made perfect sense. What unsettled him was his own lack of trepidation. He had somehow arrived at an inner peace. Maybe not the serenity of swamis and mystics, but a matter-of-fact acceptance of what was to come. If he feared anything, it was the physical act of asphyxiation—he intended to souse himself with Courvoisier and Valium before he stepped into the bathroom—but not the great nameless maw beyond. Death wasn’t an evil, not at his age. It was a neutral. Like Dr. Davin’s beer. Unnecessary suffering—now there lay the true iniquity.
“What’s most amazing,” said the rabbi—and Millard realized with guilt, like a scribe at a medieval deathbed, that he’d lost a crucial portion of Steinmetz’s final testimony—“is that people think I’ll be cheered by their own bad news. Well-wishers actually say things like, ‘If it makes you feel any better, my sister-in-law also has myeloma.’ Now how could that possibly, under any conceivable circumstances, make me feel better?”
Steinmetz readjusted his pillows, but his ongoing discomfort was obvious. “What I really want—I probably shouldn’t be saying this to a psychiatrist—is to get it over with. Not that I’m planning anything, but I wouldn’t mind if someone lit a fire under God’s ass.” The rabbi balled up a sheaf of newspaper and lobbed it toward the wastepaper basket; it fell several yards short of the rim. “I don’t really mean that. But there are moments when I find myself thinking, either let me live or let me die, but don’t keep toying with me. Don’t keep toying with my family.” The rabbi added, “When I’m alone, I use a much stronger word than toying.”
Millard glanced out the window. On the avenue, the morning sun blistered the grime coating the tops of ambulances and delivery trucks. Children cavorted in the schoolyard opposite: Tag? Kick the can? Some novel amusement? One could not tell from this height. How recently, it seemed, his brother, Lester, had been stickball king of 177th Street.
“You’re not listening,” said Steinmetz. “You have that same polite, glazed look I sometimes fall into when a sick person starts rambling.”
“I’m sorry. I got lost in my own head . . . .”
“Who could blame you?” asked the rabbi. “Don’t worry. I’m not offended. It was helpful to talk things out . . . .”
Before Millard had an opportunity to apologize further, the nursing assistant arrived to check Steinmetz’s vital signs. “Saved by the thermometer,” said the rabbi.
“I don’t want you to think . . .”
“Think what? That you’re also human? That you have worries of your own?” He extended an emaciated hand and shook Millard’s with surprising vigor.
“If I’m still around tomorrow,” said the rabbi, “you’ll make it up to me by letting me beat the pants off you at checkers.”
Millard understood that any further expression of contrition at the moment would do more harm than good. Disheartened with self-reproach, he retreated into the corridor. His watch read ten o’clock. Already, he’d fallen behind schedule.
A midmorning lull had settled over St. Dymphna’s. Interns and residents, pre-rounding complete, sipped coffee in the atrium and waited for their attendings. Visiting hours remained a gleam on the day’s horizon. An overhead page announced a Code 1000—a cardiac arrest—in a distant corner of the hospital, but the fluorescently lit walkway beneath Madison Avenue remained as still as the nave of an abandoned cathedral. Alas, even here some fastidious retainer had pinned up warnings about the missing lynx cub. Clearly, the hospital’s risk management and legal departments—the twin powers behind the throne—were taking no chances, although Millard didn’t see how warning people of the escaped lynx absolved anyone of responsibility. Once you saw the signs, after all, you’d already reached the zone of danger. Shutting down the entire facility until the animal was recaptured might shield the institution to some degree, but he had no doubt that the bean counters and actuaries had already weighed the odds of calamity against the costs of precaution and found them wanting. So here he was, on the day of his death, vigilant for a feral feline.
That’s when a crazy thought tickled his mind. There was no lynx. Most likely, the whole enterprise would prove a social psychology experiment of some sort, an assessment of how people in public settings responded to low-grade threats. Ingenious—if true! Of course, he’d never know for sure, but even if he’d lived to see a panel of investigators announce their results, even then one couldn’t truly be certain. After all, maybe they had concocted the study as a cover to hide their negligence in permitting a dangerous cat to enter a medical clinic. Who could say? He was reminded of Oedipus’s warning: Count no man happy until he is dead. While he mused on the purpose of the lynx experiment, his feet carried him toward his office, navigating the pipe-lined passageways of the hospital underbelly, where crossbeams and open ducts might conceal packs of truant panthers and ocelots. Here whirred the institution’s most essential—and least glamorous—departments: dining services, housekeeping, maintenance. Only now housekeeping was known as “environmental amenities” and maintenance had been rebranded “plant operations”—a challenge for a geezer who still thought of flight attendants as stewardesses. Opposite Millard’s office, a workman in paint-mottled coveralls was in the process of taping a pristine drop cloth along the tile while his colleague lounged against a nearby trestle ladder. Millard’s secretary, Miss Nickelsworth, had stepped away from her desk—a note read “Will return in 15 min”—and, as a stickler for protocol, she’d secured his door during her absence. Millard had the key in the lock when Hecuba Yilmaz rounded the corner like a damp breeze.
“Precisely whom I was looking for,” Yilmaz bellowed in her Turkish accent, pointing the end of her severed index finger at him. Coarse hairs protruding from the mole atop the bridge of the woman’s fleshy nose, glistening like barbs. The embossed fleur-de-lis print of her ill-fitting blouse recalled nineteenth-century upholstery. “I have been searching for you.”
“Who hasn’t?”
Yilmaz frowned as though deciding whether his remark was insulting.
“I don’t have time for you today, Hecuba.”
Millard had never personally had a run-in with this egocentric creature, but that likely made him a minority of one. Stan Laguna, who despised the young woman, alternately called her “The Royal Embellisher” (because she claimed direct descent from King Priam of Troy) and “The Beauty Queen of Sycamore Hill,” (not in tribute to her appearance, which resembled a well-fed aardvark’s, but with ironic reference to the location of the second-rate satellite hospital—a St. Dymphna’s affiliate on Sycamore Hill Boulevard in Queens—where she ran a methadone clinic). Her much older husband, the outside hospital’s chief operating officer, was a former insurance company litigator who bore a striking resemblance to vintage character actor Karl Malden, and had been a chum of the dean’s during his Andover years. That had led Laguna to remark, too loud, at last year’s Christmas party, “Apparently screwing Mr. Snout gives her license to screw the rest of us.” And once, when a colleague observed of the peculiar couple that “every pot has its lid,” Stan had pointed out that the correct quotation from Balzac (and when had Stan Laguna ever been the sort to read Balzac?) read: “There is no pot, however ugly, that does not one day find a cover.”
“We can talk tomorrow,” Millard pledged. “I’m free all afternoon.”
He didn’t want to unlock his office door until the woman departed.
She scrutinized him, as intense as the Grand Inquisitor. “You are going to be here tomorrow, are you not? You are not planning a vacation.”
“No,” he assured her. “I am not planning a vacation.”
That didn’t seem enough to pacify her.
“All I need is five minutes. Five minutes.” She held up her hand, four-and-a-half knotty fingers splayed, as though the concept might be alien to him. “You cannot possibly be so busy that you cannot spare five minutes for an old friend, can you?”
“I can’t spare you even four-and-a-half minutes, Hecuba. Not today.”
“But you must,” she insisted, oblivious to his malice. “To tell you the truth, I have heard a rumor that you are stepping down.”
He turned to face her, his back against his office door.
“Who told you that?”
“I’d rather not say,” said Hecuba. “But if it’s true, I feel you owe it to me to tell me. I don’t think it’s any secret that I’m interested in the position—when you’re ready to step down—and I’m hoping we can arrange a seamless transition.”
“A seamless transition?” echoed Millard.
“That’s all I’m requesting.”
Did this woman really believe he owed her anything? Phenomenal! If he owed her something, it was, as Jackie Gleason would have said, a good sock in the kisser. How could a forty-something assistant professor believe herself in line for his job? No sane person would appoint Hecuba Yilmaz dog catcher, let alone head of her own division, but he’d served up similar predictions many times before, only to be proven wrong. Anything was possible in academia, especially with the right bedfellows.
“I do not want there to be any conflict between myself and Stanley,” she said. Yilmaz had the habit of calling people by their “full” names—which often involved butchering these names for her own pleasure, almost sadistically, as though the distortions gave her power over her victims like the spells of a Shakespearean witch. Stan Laguna’s given name was actually Stanislaw. “People will commend you for a smooth transition, Millard. I am looking out for your legacy.”
Yilmaz touched him on the elbow—a benign gesture that, bestowed by another party, might have come across as endearing, but originating from Hecuba, the act made him want to wrest free his arm. Or change his clothes.
“Thanks for your concern, but rumors of my retirement are greatly exaggerated,” he said. “Especially anonymous ones. I’m far more likely to die than to retire.” He looked pointedly at his wristwatch: nearly twenty past ten. “If I plan on expiring unexpectedly, would you like me to give you advance notice?”
“I am sorry,” answered Yilmaz, “but it is irresponsible to leave these things up in the air.”
“I’m sure you’re right,” he agreed. “I am a grossly irresponsible person.”
He’d given up on courtesy; now he was merely striving to remain civil. Already, a fantasy was leaching into his psyche, a desire to tell this hideous woman exactly what he thought of her.
“Come back tomorrow, Hecuba . . . .”
“You’ll be here? You’re not going to phone in sick, are you?”
“Even if I’m dying of cholera or yellow fever, I won’t call in sick.”
He unlocked his office door.
“Five minutes? Is that really so much to ask?”
“At the moment, I’m afraid it is,” he said—and he shut the door behind him.
You’re an unbearable narcissist and nobody likes you, he thought, but he resisted his compulsion to reopen the door and give voice to his contempt. Because even if he told her how unpleasant he found her, she wouldn’t believe him. That was the amazing thing about disturbed personalities like Hecuba’s: everybody else suffered, but she plowed forward without insight, sowing exasperation and fury in cheerful oblivion.