CHAPTER THREE

Most of Balint’s patients were hopeless cases. These men and women had already failed fluid restriction, digoxin, aldosterone antagonists. They’d visited cardiologists up and down the East Coast, paid out-of-pocket for third and fourth opinions. Unfortunately, what they needed were new hearts, substitute organs to replace their own failing tissue, but new hearts were in critically short supply. So they waited. And they suffered, sleeping on stacks of pillows to help them breathe. And a lucky few survived long enough for Warren Sugarman or Chester Pastarnack to slice open their chests and to rejuvenate them with a blood pump salvaged from a motorcycle fatality or a gunshot victim. For that’s all the human heart really is: a relentless blood pump. Several times a month, Balint had the unpleasant duty of phoning the family members of one of his patients and informing them that, in the case of their loved one, the original pump had stopped working too soon.

Norman Navare was such a hopeless case. He’d been referred to Laurendale from a community hospital in Elizabeth Lakes on the remote chance that Balint might be able to slip him onto the transplant list. One look at his chart was all it took to recognize that the odds were grim. Navare was sixty-four—at the cusp of too old. He had diabetes, another strike. But his largest problem was that his heart’s ejection fraction had been measured at 14 percent. Anything below 15 percent was dire, a number below 10 percent usually incompatible with life. Even if he were eligible for an organ, he had little prospect of surviving until one became available. But Balint had agreed to see him—cultivating good relationships with Laurendale’s satellite hospitals was a crucial aspect of what made an effective division chief—and in late September, the man had arrived for his first appointment in the company of his adult daughter. Navare, despite his bleak health, displayed the confidence and flair of a man who had once been exceedingly handsome. He sported a guayabera and a Panama hat that gave him the look of a playboy from prerevolution Havana. But Balint hardly noticed the man’s rugged features, because he was immediately captivated by the black-eyed brunette at his patient’s side: Navare’s daughter was the most beautiful woman that Balint had ever laid eyes upon.

“We’re so grateful to you for seeing us,” she said. She appeared to be about twenty-five. “We tried to get an appointment at Cornell, but they wanted us to wait six weeks. The Brigham in Boston wouldn’t see us at all.”

Balint noted the girl wasn’t wearing a wedding ring. He hoped that she hadn’t spotted his own. As the diseased man settled himself into a chair, Balint concealed his hands beneath the desk and clandestinely slid the gold band off his finger. What authority did Amanda have to complain? If she spent her Saturdays on the sofa in Sugarman’s den, he had every right to flirt with anyone he damn pleased.

“Well, that’s their loss,” said Balint. “Some of these fancy hospitals take only the easy cases. They’re more concerned about padding numbers than with saving lives. It’s sad. But I promise you we’ll do the best for your father.”

“So you think you can get him a heart?”

Usually, this was the moment where Balint warned patients and families that he couldn’t make any promises. Instead, he said, “I’m certainly going to try like hell. If my own father needed a heart, I wouldn’t try any harder.”

The girl’s eyes glowed. “Did you hear that, Papa? That’s not something you hear every day from a doctor.”

Her father nodded. “We’ll see what happens.”

Navare sounded short of breath. Balint listened to his heart and lungs with a stethoscope. He held his own shoulders out and sucked in his stomach while conducting the physical, striving to appear dashing—or, at least, professional.

“I’m Delilah, by the way,” said the girl. “Like the woman in the Bible who gives Samson that nasty haircut. But I’m a nurse, not a hairdresser. A nursing student, really—for another nine months.” Her voice was tender and intensely feminine, a striking contrast to Amanda’s no-nonsense manner of speaking. “Forgive me for saying this, Dr. Balint, but I want you to know that we’ve seen God-knows-how-many cardiologists over the past few years, and you’re the first one who didn’t treat Papa like a number. Most of them look at his ejection fraction and more or less bury him alive.”

“There’s a lesson in that. Don’t die on one doctor’s opinion,” said Balint. Then he took a risk and added, “But please, call me Jeremy. In Hebrew, it’s Jeremiah. Like the guy in the Bible who complains a lot.”

To his surprise, Delilah Navare laughed. A high-pitched, almost musical laugh. Even her father cracked a thin smile.

“I’d like to see you every three weeks, Mr. Navare,” said Balint—which was twice as often as he usually booked his heart failure patients. “We’ll set up some evaluations for you and get you on as many transplant lists as possible . . . and then we’ll have to keep you alive until you reach the top. There’s no choice in the matter. How does that sound?”

“Sounds reasonable,” answered Navare. “If it happens, then it will sound good.”

“Fair enough.” Balint liked the man’s style, the sort of stoic reserve that comes from a lifetime of disappointment. “I’m going to give my cell phone number to your daughter. You have any concerns or questions—any at all—you call me. Night or day. I mean it. If I find out you have an emergency and you don’t call me, I’m going to be mad as hell.” He wrote his private number on the flip side of a business card. “I’m also going to include my pager number. It’s always on—so no excuses.”

Balint passed the card to Delilah and she thanked him. Then he took the liberty of escorting the patient and his daughter out to the elevators. He found himself wondering whether this girl was truly the most beautiful woman he’d ever seen, or whether there had been others whom he hadn’t noticed because he’d been fully committed to Amanda. He couldn’t be certain. What he did know was that Delilah Navare was stunningly attractive—and he had every intention of seeing her outside his office.

DELILAH INTRIGUED him; she didn’t distract him from his mission. Once he’d mapped out the general contours of his scheme, Balint set about methodically laying the groundwork. Most murderers killed in haste, desperation trumping their common sense. But Balint promised himself that he wouldn’t act prematurely. Whether it took him two years to bump off Sugarman, or ten, was entirely beside the point. Hadn’t it taken Oppenheimer half a decade to build an atomic bomb? Every step from acquiring the materials to selecting his victims—he’d decided that his plan required multiple victims—deserved the same painstaking care as a heart transplant. So while he’d charted his strategy in his head, Balint held off an entire month before launching his first preparations. If a month goes by and I still don’t uncover any glitches, he assured himself, that will be my cue to act.

In early October, he finally felt comfortable enough with his plan to begin assembling his equipment. Even before he purchased any supplies, he required a safe place to store them. Balint didn’t dare conceal them inside his home, where one of the girls might stumble upon the evidence at the bottom of a drawer or behind the boiler. For a few days, he contemplated stashing his materials in his office—possibly in the locked cabinet where he kept an emergency supply of tranquilizers and analgesics—but he knew that he’d never sleep easy while the cleaning crew had access to the suite at night. It was true that he possessed the only key to the cabinet; he could even have installed a second strongbox beyond its steel doors. Yet he couldn’t risk one of the maintenance workers jimmying the lock in search of pharmaceuticals or cash. Eventually he decided that the safest hiding place was his stepfather’s fishing cabin on Lake Shearwater, an hour west of Laurendale in the Onaswego Hills.

The two-room cedar cabin had been in Henry Serspin-sky’s family for multiple generations. Shortly after he’d married Balint’s mother—her second marriage, his third—the veterinarian invited his new stepson out for a weekend of hooking trout. Balint had been in college at the time. They’d repeated the pilgrimage annually, for another eight years, until Balint acquired children of his own and the retired vet declared himself “too old” to survive without creature comforts. On the final few excursions, the old man had needed to return to shore frequently to self-catheterize. Every year, Balint promised himself he’d make the trip on his own—or at least help Serspinsky rent out the cabin for a profit—but all he ever managed to do was drive to the site for a couple of hours to check on the upkeep and make sure squatters hadn’t burned down the place. It was a secluded structure at the end of a shaded dirt lane, and since the state’s Fish and Game Bureau had stopped stocking Lake Shearwater with trout several years earlier, even the neighboring lodges went largely unvisited. In short, the cabin offered the perfect spot to salt away his supplies.

Balint drove out one day after work. Nothing strange about that, he assured himself. Early autumn was usually the season he inspected the property. Yet even as he steered up the poorly maintained roadway, his adrenaline surged. After weeks of planning, he was finally taking action.

The cabin was almost exactly as he’d left it twelve months earlier: same squeaking front step, same burned-out light bulb in the bedroom, same aroma of wood chips. None of the dust on the floorboards appeared disturbed. Along the far wall, Serspinsky’s shelf of “inventor’s tools” gathered dust. Someone or something had shattered one of the cabin’s windowpanes, but the lock on the sash below didn’t bear any indications of tampering. Balint slipped into a pair of gloves. No reason to risk leaving stray fingerprints in whatever nook he selected as a hiding place—on the extremely remote chance that the authorities ever did search the cabin. But where to conceal his gear? His first instinct had been among the box springs beneath the bed; then it crossed his mind that a potential squatter might shift the mattress if he found himself unable to sleep. Instead Balint located a steamer trunk inside one of the closets that contained an assortment of tablecloths and draperies and vintage women’s undergarments. A few strands of ribbon and a pair of scissors, tucked into the bottom of such a chest, would hardly draw notice.

On his way out, Balint dusted the entire cabin and fractured a second, larger windowpane, creating the illusion that a squatter had been trespassing on the premises. Even if the police ever found his supplies, he could deny knowing how they’d gotten there.

His next step was to acquire the ribbon itself. He had to obtain a sufficient length to last him through his spree—but not so much that buying it attracted notice. Obviously he did not want to have to purchase additional ribbon after the initial murder. Here, he congratulated himself on making his first wise choice. Although he had a hypertension conference in Las Vegas on his calendar for the second weekend of the month, where he could easily have bought the ribbon at a local stationery shop—far from New Jersey, in case anybody ever tracked the materials to their point-of-sale—he realized that he’d draw suspicion if he wore gloves into a store in the Nevada desert during October. Not wearing gloves, however, ran the risk of leaving fingerprints on the ribbon. So he held off. Two weeks later, at the American Cardiology Association meetings in Minneapolis, he drove out to a suburban shopping plaza and purchased his supplies. (He avoided the city itself, because he’d read that some urban centers—New York, Washington—now had police cameras mounted along every block. He hadn’t been able to find any evidence of Big Brother in Minneapolis, but why take chances?) It was a windy, bracing afternoon and his leather gloves, if not essential, didn’t stand out.

Balint chose green ribbon. His inspiration was the Red Ribbon Strangler, who’d terrorized Creve Coeur, Rhode Island, in the 1960s, but he feared—irrationally—that someone might associate red with blood, and from blood it was a short leap to cardiology. He also considered yellow, but too many families used yellow ribbon for a military tribute, and he didn’t want the authorities thinking the choice of yellow ribbon was incidental, that he’d found the trimming at the crime scene and made use of it. No, he needed them to think the killings were carefully planned. Black posed similar problems. Lots of people already owned black ribbons—employed them to transform hats and dresses into funeral attire. So green. He bought enough ribbon to produce thirty-two identical two-foot-long strands, far more than he anticipated using. He also purchased three packages of wrapping paper, an assortment of children’s toys, a pin-the-tail-on-the-donkey set, and sufficient party favors to entertain every six-year-old child in Minnesota.

“What birthday is this for your kid?” asked the sales clerk.

“My niece,” he replied, correcting the girl in an effort to make his deception sound authentic. “Six—going on sixteen.”

Balint found himself glancing at the girl’s cleavage, something he would never have done in his previous existence. She was cute. Not stunning like Delilah, but pretty enough. Under different circumstances—had he not been accruing supplies for his killing spree—he might have flirted, or even invited her out for a cup of coffee. Instead he thanked her politely and asked her to double bag his purchases. Then he traveled across the city to a different suburban shopping plaza and deposited all of the merchandise, except for the ribbon and scissors, into a Salvation Army dumpster. The following Tuesday morning, he detoured to Lake Shearwater on his way home from the airport and secured his equipment inside the steamer trunk.

WHILE BALINT led a second life, amassing the accoutrements for his vengeance, his first life continued in all its regular chaos. He attended Allison Sucram’s wedding, to a red-haired woman in a wheelchair, and spent the reception discussing with the tax attorney seated to his right whether it was grammatically preferable to refer to the couple as two brides, or as spouse and spouse. He remembered only one other event from the evening: an aunt of the bride—the bride whose parents played bridge with Amanda—approached him in the cloakroom of the Waldorf Astoria Hotel, where the reception had taken place, to ask whether her diuretic could be responsible for her rash. At the end of the evening, he still wasn’t sure whether he’d ever met the Sucrams before.

Later that month, he also attended a bar mitzvah in Philadelphia for the son of Amanda’s childhood piano teacher and a funeral for the father of a woman from her former “babies group.” He strove to appear extra attentive to his wife and to avoid arguments. He deferred to her on matters over which they might previously have bickered—like whether Jessie was too young to trick-or-treat without a chaperone. To outsiders, they must have appeared the perfect couple. To Balint, it felt as though they talked much less than they had previously—or, at least, less intimately—but he couldn’t actually pinpoint any specific examples. Maybe, it crossed his mind, they’d never spoken to each other with much intimacy.

In mid-October, Balint’s mother tripped in the produce aisle at the Shop ’n Save and fractured her hip and her collarbone. She required a two-day stay in the hospital, six weeks of casting, and then another three months of rehab. She also required twenty-four-hour attention—a level of care that her husband couldn’t manage alone. During her first few weeks at home, Balint spent nearly every night in Hager Heights. Even Amanda had no excuse to justify staying away. He derived particular pleasure in insisting that his wife join him and the girls for lunch at the retirement village the following Saturday, claiming that he couldn’t look after both his mother and his daughters at the same time, all the while knowing this would disrupt Amanda’s date with Sugarman. She offered no objection. For a woman conducting an affair, she had a frustrating knack for prioritizing her own family—and this made it difficult for Balint to stay angry with her.

Work also kept Balint busy. Chester Pastarnack, the senior heart-transplant surgeon at Laurendale-Methodist, announced his retirement—effective the first of November. Shortly afterward, Warren Sugarman, at thirty-five, was appointed acting head of thoracic surgery. That meant he joined the Wednesday morning leadership meetings that Balint attended each week, forcing him to endure his rival’s banter over croissants and coffee. It also meant that if he murdered Sugarman before Laurendale recruited a second heart-transplant surgeon, his crime would effectively shut down the hospital’s entire program for the time being. Unless, of course, Pastarnack agreed to come out of retirement during the crisis. Balint crossed paths with Sugarman at the synagogue on the second day of Rosh Hashanah and congratulated his rival on his promotion. “More like a punishment,” observed Sugarman. “I work harder . . . and Gloria gets more alimony.” But he sensed the smug bastard was pleased as punch.

Balint found himself acutely aware of how peculiar it felt to be preparing for another man’s assassination—attending to the gruesome business in a detached, practical manner, as though arranging a medical symposium—but he refused to let these feelings trouble him. Occasionally, he even saw the matter-of-fact nature of his preparations as humorous. For instance, one day Jessie repeated a John Lennon quotation she’d picked up at school: “Life is what happens while you’re busy making other plans.” How very true. At the same time, Balint thought to himself with amusement, he highly doubted that his variety of plans were what the singer had meant.

DELILAH NAVARE telephoned after nine o’clock on a Sunday evening. Balint had finished reading The Remarkable Story of Chicken Little to the girls, and was sitting in his study, his legs propped atop his ink blotter, proofreading a review article on valvular diseases. Amanda lay in bed upstairs, watching a documentary about female aviators. Or perhaps she’d already drifted off to sleep. He answered the call with irritation, assuming the hospital’s page operator had phoned the wrong service attending by mistake.

“Dr. Balint?” asked the delicate voice. “I’m so sorry to call you this late. I hope I didn’t wake you.”

He recognized her immediately. “Delilah?”

“You said we should call anytime—or I never would have interrupted your weekend. Is now an okay moment?”

“It’s fine. Just fine. What’s going on?”

“Papa’s getting worse,” she explained. “I’m scared.”

She had phoned from the emergency room at Laurendale. As soon as he hung up the receiver, Balint tracked down the night resident in the ER and learned that the team planned to admit Norman Navare for management of fluid overload. Thirty-five minutes later—after kissing his daughters and urging Amanda not to remain awake—he strode across the ambulance bay in his crisp, knee-length white coat.

“Dr. Balint. Chief of cardiology,” he introduced himself to the dumbstruck emergency resident. “You can admit Mr. Navare under my name. VIP. If we have any private rooms that we can comp for him, make it happen.”

“Sure thing,” agreed the junior clinician. “I didn’t realize . . .”

“Of course, you didn’t. If Jesus Christ showed up at this hospital, you’d tag him as a homeless dude wearing a loincloth and keep him waiting for hours. Now please do your best to keep Mr. Navare comfortable.”

He poked his head around several curtains before he found the out-of-the-way alcove to which they’d consigned Delilah’s father. The patient sat propped at a right angle to the bed, on cannular oxygen, yet he still appeared desperate for air. Some idiot hadn’t properly removed the EKG electrodes from his chest, leaving the poor man’s hirsute body dappled with adhesives. His daughter stood beneath the cardiac monitor, dabbing his forehead with a damp towel. “Dr. Balint,” she exclaimed in surprise. “I figured you’d stop by in the morning. I didn’t dream you’d show up tonight.”

“Jeremy,” he corrected her. “Please.”

Something in his tone penetrated her reserve—and registered his intentions. This was her opportunity to draw a line in the sand, if she so desired, to remind him ever so subtly that he was her father’s cardiologist, not her friend. Balint actually felt as nervous as a teenager for a moment—as on edge as he’d been sixteen years earlier when he’d invited Molly what’s-her-name to the senior class prom. Certainly far more tense than he had felt while stockpiling materials for his murder plot. But to his relief, Delilah smiled—a gentle, unmistakably inviting smile—and she said, “Jeremy.” Just his name. Nothing more. But in those three syllables, she’d communicated everything Balint needed to know.

Once the overnight nursing administrator learned to her surprise that Norman Navare, a Venezuelan-born disabled housepainter, was a VIP patient, and that the chief of cardiology had come to see him in person on a Sunday evening, she managed to find the man a complimentary private room in under an hour. Navare’s lab values came back better than Balint had anticipated. His oxygen saturation improved. With the appropriate pills and fluid regulation, he’d do fine—at least in the short run. Over the long haul, of course, he’d end up in the emergency room again sooner rather than later.

“I do believe we have everything under control,” Balint assured both father and daughter, once the patient was safely ensconced in his room on the hospital’s luxurious top floor. Outside, the lights of the mansions along Laurendale Beach twinkled down to the coast. “You’ll be back on your feet in a couple of days—tops. Maybe tomorrow.”

“From your mouth to God’s ears,” said Navare.

“I’m sorry I dragged you out of bed,” said Delilah, but now she sounded affectionate and not particularly apologetic. “I didn’t know where else to turn. It’s just been the two of us since my mother passed away . . .”

“I’m glad you dragged me out of bed. I’ll stop by in the morning, but I’ll have my phone on all night.”

Suddenly, Delilah clasped his hand and squeezed it. “Thank you, Jeremy,” she said. “I trust you.”

THIS LATE-NIGHT exchange with Delilah reminded Balint of the key advantage he had in comparison with history’s other murderers. People trusted doctors. People also harbored strong prejudices regarding serial killers. The men who shot strangers or blew up public fountains were assumed to be loners, delinquents, enemies of civilization. Poor, hungry bastards who thought too much. Theodore Kaczynski. Not leading cardiologists at tertiary medical centers, certainly not the husbands of tennis-playing librarians or the fathers of adorable, well-adjusted princesses. Never Alpha Omega Alpha graduates of Ivy League medical schools and fellows of the American College of Physicians and founding members of the Hager Park Racquetball Association. In short, beyond all of his painstaking preparations, he benefited from the simple reality that he didn’t remotely fit the bill of what people expected from a sociopath. Whether he actually was a sociopath, Balint decided, was not worth thinking about. All that he knew for certain was that life had dealt him an unjust hand and he was evening out the score.

If he’d harbored any doubts—which he didn’t—his confrontation with Sugarman the next morning would easily have banished them. The disagreement erupted at the monthly heart-transplant summit, a seven A.M. session during which senior clinicians from various disciplines reviewed which patients should be eligible for organs. When Balint arrived, exhausted after only four hours of sleep, he found his colleague already seated in the conference room. Sugarman raised his Styrofoam coffee cup to acknowledge his arrival. “How are you, Balint?”

“Almost awake.”

He retrieved an agenda from the stack at the door. In twos and threes, the representatives of the various departments and services dallied in: anesthesia, nursing, psychiatry. Balint waited for Chester Pastarnack to arrive—but then, to his surprise, Sugarman called the meeting to order. The baton, it appeared, already had been passed. No longer would Pastarnack’s bald crown with its enormous brow make final determinations of life and death. They had entered the Sugarman era. Balint’s nemesis was now to play God, at least for the short time on earth still allotted to him.

“I saw your patient Navare this morning, Balint,” began Sugarman. “You can’t seriously want to list him?”

“But I do. Why not? He’s under sixty-five. He’s got strong family support.”

Sugarman shook his head. “Pardon my French, Jeremy, but he’s a fucking nightmare. The guy’s a poorly controlled diabetic on the brink of renal failure. He could be Dickgoddamn-Cheney and I wouldn’t cut open his chest.”

An awkward silence settled over the conference room. These transplant summits were usually harmonious affairs, a collaborative effort. Chester Pastarnack rarely spoke until every participant had received an opportunity to offer his ten cents—and he certainly never used profanity. On occasion, Pastarnack had even been known to solicit an opinion from one of the medical students or nursing trainees who observed the meeting from the folding chairs along the rear wall.

“Am I crazy, people?” asked Sugarman. “Or am I missing something?”

Balint’s eyes wandered from face to face. He could have kissed the consult-liaison psychiatrist—a dour German woman old enough to be his grandmother—when she offered a tepid word of support. “That man possesses a will to live,” she said. “I met with him for two hours last week. Psychologically, he’s an excellent candidate.”

“Anybody else?” asked Sugarman.

“The daughter is a nursing student,” observed one of the nursing coordinators. “I’m just throwing that out there.”

Sugarman raised his eyebrows. “Okay, she’s a nursing student. Good for her. But what am I supposed to do with that information?”

“She’ll be able to look after him,” ventured the psychiatrist.

Sugarman grinned—an ugly grin. “If I have to play the bad guy, then I have to play the bad guy. Say we give your friend a heart, Balint, he’s got a one-in-three chance of dying on the table. Even money, he’s dead in a month. And do you really want to tell the parents of some twenty-year-old athlete with cardiomyopathy who doesn’t get that heart that we had to kill their kid—which is, in essence, what we’d be doing—so the chief of cardiology could try to buck the odds?”

That was the final verdict. They passed over Delilah’s father and moved on to the next candidate. Balint didn’t absorb another word that was said all morning. When the meeting ended, he hardly noticed. Only after Sugarman approached him and placed his hand on Balint’s shoulder did he register that it was time to leave.

“It’s not personal, Jeremy. He’s a lousy candidate. If we had more organs, it would be different. You know how it is . . .”

“Of course, it’s personal,” snapped Balint. “Maybe not for you. But for Norman Navare and his daughter, you bet your ass it’s damn personal. Where do you get off playing God all of a sudden, Sugarman? Are you even an organ donor?”

“Whoa, cowboy. What’s gotten into you?”

Balint realized he was on the brink of ruining everything. If word got around that bad blood had brewed between him and Sugarman before the murder, it would only be a matter of time before the authorities discovered Amanda’s affair—and then all would be lost. His only option was to swallow his pride and apologize.

“I’m sorry, Warren. I shouldn’t have said that. I was way out of line,” he said.

“Don’t think twice. We all have our moments.” He flashed Balint a benevolent smile. “No harm, no foul.”

Balint placed his hand atop of the surgeon’s. It was the only way. “Navare is a family friend . . .”

“I had no idea. I’m sorry,” said Sugarman. Balint hated the man now more than ever—despised him for his sympathy above all else. “If I thought he had a remote chance, you understand, I’d bend over backward . . .”

Balint stood up and Sugarman gave him a hug—the sort of macho half embrace exchanged by clergymen and mobsters. Perfect. At least a dozen witnesses had seen them make up. But to Balint, his rival’s embrace was more than hypocrisy. The arms locked around his torso were already the icy limbs of a cadaver.