Nick stepped back from the autopsy table, pressed the pedal under his right foot, and spoke into the microphone hanging near his head. "No other abnormalities noted. The balance of findings will be dictated after review of the histopathology specimens and the results of the toxicology tests. Usual signature. Thanks." He turned away from the body and gestured to the morgue assistant to close the incisions. "I'll be in the office if you need me. Thanks for your help." Nick removed his goggles and stripped offhis mask, gown, and gloves. He was standing at the sink outside the autopsy room, drying his hands, when he heard footsteps hurrying down the corridor toward him. He turned to see a woman approaching. The attractive redhead wore surgical scrubs, covered by a white coat. As she neared him, he could make out the embroidered name above the breast pocket: Anna McIntyre, MD. She stopped in front of him, and the set of her jaw and the flash of her green eyes told Nick she was in no mood for light banter. "Dr. McIntyre?" She nodded. "Nick Valentine. I paged you, but when you didn't answer I had to go ahead and get started. Sorry." She waved away his apology. "No, it's my fault. I couldn't break free to answer your page. What can you tell me?" "Why don't I buy you a cup of coffee and I'll tell you what I've found so far? If we go to the food court, we can get away from the smell down here." She hesitated for a few seconds. "Okay. Lead the way." It seemed to Nick there was a Starbucks on every corner of every major city in the U.S. Most important to him, however, was the one here in the basement of the Clinical Sciences Building at Southwestern Medical Center. As he waited to order, he sniffed the rich aromas that filled the air. The smell of coffee never failed to lift his spirits. Maybe it would do the same for the woman who stood stoop-shouldered beside him. For most doctors, caffeine was the engine that helped propel them through long days and longer nights. Maybe all she needed was a booster shot. When they were seated at a corner table with their venti lattes, Nick filled her in on his findings at the autopsy he'd just completed. "That's about it," he concluded. "I'll sign the death certificate with the preliminary cause of death as anaphylaxis due to an unknown cause." "But you won't have a final diagnosis until—" "Right. I'll review the tissue samples and the results of the toxicology screen, but I doubt that we'll find anything there. I'll have some tests run on the blood samples I took, and maybe that will help us. I'll need to research whether there's a good blood test for a drug reaction or latex allergy. The long and short of it is that we may never know the real reason he developed anaphylaxis and died." "I hadn't even thought of latex allergy," she said. "But that's pretty rare, isn't it?" "Less than one percent of the population. Seen in people chronically exposed to latex: surgeons and nurses, industrial workers, patients with lifelong indwelling catheters." He felt himself slipping into his lecture mode and made an effort to pull back. "I mean, we could talk about all these uncommon things, but I'll bet you learned the same thing in medical school that I did. When you hear hoof beats—" "Think horses, not zebras." She managed a tiny smile. "Yes, I know. So we should concentrate on the blood or the antibiotic. If it was the blood, there's a problem in the blood bank because he got one unit of unmatched O negative, which should have been okay, and one unit that was supposedly compatible by cross-match." "The residuals in both bags of blood are being re-typed and cross-matched against your patient's blood as we speak. We'll know the answer by the time we finish our coffee." He drank deeply from his cup. "Don't you think an antibiotic reaction is the most likely cause?" She took a sip of coffee. "Probably, although I hope not. Choosing an antibiotic wasn't a routine matter, because we didn't know if Hatley had any drug allergies. The resident— one of our sharpest ones, by the way—thought he'd see if we could get the information another way. He had medical records check for a previous visit for the patient. They found a recent emergency room visit by the patient where he tolerated Omnilex. Since that antibiotic's the best choice to cover spillage from a perforated bowel, I agreed with Luc when he ordered it." "But—" "I know. If you give that drug to a patient who's allergic to it or to penicillin, their reaction is likely to be severe—like this one. But I thought, since we had that history of tolerance, it was okay." She blinked hard. "I should have known better. Should have made him use a different drug." Nick sensed he was treading on thin ice here. Maybe he should change the subject. Besides, he wanted to know more about this woman. "You know, I've seen you in the halls, but we've never actually met. Did you train here?" She hesitated before reeling offwhat had apparently become a stock answer. "Raised in Oklahoma. Graduated from med school in North Carolina. Duke, actually. Lucky enough to get a surgery residency here at Parkland, and when I finished I was offered a faculty position in the Surgery Department. I've been here a little less than a year now." Nick held up a hand, palm out. "I know better. You don't get a surgery residency here because you're 'lucky.' You get one because you're good. Let me guess. AOA at Duke?" If Anna was Alpha Omega Alpha, she must have been in the top ten percent of her class. "Right. But I don't guess it's enough to be bright if you foul up and cost a patient his life." She drank from her cup, and Nick noticed that she swallowed several more times after that. Nick was barely aware of the activity around him, the ebb and flow of people, the sounds of pagers punctuating dozens of conversations. All he saw was Anna. She was one of the most attractive women he'd encountered in quite a while. But he was certain there was more to this trim, green-eyed redhead than striking good looks. Right now she was focused on medicine—it was obvious she cared a great deal about her patients, and this loss hit her hard—but Nick had a sense that in a different setting she'd be fun to know. And he intended to see if he couldn't arrange that. Anna shifted in her chair. He couldn't let her leave yet. "Wait a minute," he said. "Aren't you curious about me at all? There may be a prize if you can answer all the questions later." Did he see the ghost of a grin? "Sure. Why not? What's your story—the Reader's Digest version?" Nick moved his cup aside and leaned forward with his elbows on the table. He wasn't sure how much longer he could draw out their time together, but he was determined to give it his best shot. "My roots are Italian. Named for my grandfather. He was Nicolo Valentino when he got offthe boat, changed his name when he got his citizenship. I'm Nicolo the Third." He ticked offthe points on his fingers. "Worked my way through premed at Texas Tech. Got into the med school there by the skin of my teeth. Managed to get a residency in pathology here at Southwestern. When I finished, they had an opening in the department." He held out his hand, palm up, fingers spread, thumb tucked under. "So here I am—four years in the department, still an Assistant Professor. Up for promotion now, and I suspect that if I don't make it they'll cut me like a dead branch from a tree." Nick's last sentence rang a faint alarm bell in his head. He had to finish that project or the chairman would be royally ticked off, but it only took Nick a second to put that chore out of his mind. He was sitting with the most beautiful woman he'd ever met. He wanted to get to know her better, and he intended to keep her here as long as possible, even if it meant incurring Dr. Wetherington's wrath. ANNA STRODE DOWN THE HALL TOWARD HER OFFICE WHEN A FAMILIAR voice stopped her. "What's your hurry?" She turned and glared at Dr. Buddy Jenkins. "Some of us have responsibilities." "What are you so upset about, Anna?" The anesthesiologist's easy East Texas drawl almost sent Anna into orbit. Didn't he remember that a patient had died today, one who might have been saved if the anesthesia resident had picked up on the diagnosis in time to start proper treatment? Or if Jenkins hadn't been out in the hall having a cup of coffee and chatting with a colleague about the Cowboys or some other sports team? She had to unclench her teeth before she forced the words out. "Buddy, why was that resident alone in there?" "Well, I might ask the same thing about Luc Nguyn. He was doing the case without staffsupervision until you scrubbed in to check his work. And that's because you trusted him—with good reason." Jenkins sipped from the Styrofoam cup he held."Murray's inexperienced, but he's okay with the routine stuff. I was there with him to get the case started. I was staffing two rooms today because one of the other faculty anesthesiologists is out sick. I popped in and checked on things periodically, and everything seemed to be going fine. It's unfortunate that Murray missed the signs of anaphylaxis until it was wellestablished."He opened his mouth, but closed it again without saying more. Anna sighed. "I know, Buddy. I shouldn't be taking it out on the anesthesiologist. Luc should have thought of anaphylaxis too. Hey, I should have thought of it. After all, it's ultimately my responsibility. And you know as well as I that doctors can't be right most of the time. We have to be right all the time." "Never happen," Buddy said. "We all make mistakes. We just have to learn from them and move on." "Well, I'm not moving on until I get the answer to this one. There was no reason that patient should have had that reaction in the first place." "Fine. Happy hunting. I'll see you at M&M, and we'll kick it around some more." Buddy lifted his cup in a silent salute, then walked away. He'd see her at M&M. Not the candy. Anna wished it were. No, this was Morbidity and Mortality Conference, the meeting each month when the staffdiscussed their patients who had suffered adverse consequences from treatment. "Morbidity" sounded so much better than "something went wrong." And "mortality" was more acceptable than "they died." But when it came to assigning blame, there was no sugar coating here. Anna dreaded the upcoming M&M conference, where the death of Eric Hatley would be discussed. Until then, she intended to keep looking into why he had died. Was it possible that the anesthesia resident had given the wrong medication? Or mismanaged the anesthesia in some way? She kept coming back to the fact that Dr. Murray was inexperienced and on his own. Or did the blame rest with Luc? A preventable death would leave a black mark, not only on his record but also on his conscience. She'd heard of situations like this that ruined promising careers, sending gifted surgeons into specialties where they could avoid having to make rapid-fire, life-or-death decisions. Her pager brought her back to the moment. She recognized the number immediately: the chairman's office. She knew what Dr. Fowler wanted to discuss, and it brought more questions to her mind. Would she even be around to look into this case? Or would she be embroiled in something that didn't involve the death of her patient, but rather, the death of her professional career? Anna squirmed in her chair and tried to ignore the lump stuck in her throat. "Dr. Fowler, why didn't you call and let me know those DEA agents were coming?" "Because I didn't know. They came by and asked my administrative assistant how to find your office. I never saw them, never knew they were here." Neil Fowler adjusted the knot of his tie, leaned back in his chair, and looked across his desk at Anna. "Tell me what they said." She took a deep breath and launched into a retelling of her session with Hale and Kramer. As he listened, Fowler's expression revealed nothing. He'd been chairman of the Surgery Department for ten years—the youngest chairman at the medical center—and had a reputation for being stern but fair. Anna figured he'd seen it all and dealt with it before. Maybe that's why he could appear so calm. But this was all new to her. When Anna finished, Fowler fixed her with calm, gray eyes."And they told you they'd be terminating your ability to write for narcotics?" "I'm supposed to receive a special delivery letter tomorrow from the DEA. And they said 'suspended,' not 'terminated.' " Fowler leaned forward and rested his hands on the desk in front of him. "Anna, I'm not going to prejudge this matter, and I'll try to help if I can. But first, I have to ask you this. Did you write those prescriptions?" "Absolutely not!" She was surprised at the fervor of her answer. "Sorry. I didn't mean to jump at you. No, I did not write them." "All right. Here's where we need to go. First of all, before you leave the office I'm going to get Laura Ernst on the phone, and you're going to tell her what just went down." "Who's she?" "She heads the legal department at the school. If you end up being charged with something, you'll need your own lawyer. But I want Laura to be aware of this from the get-go."For a second, the corners of Fowler's mouth lifted a fraction."Laura's wound pretty tight, but in a fight you'll be glad to have her on your side." Anna's brain was moving about a mile a minute. "What about my clinical work? I can't write for any narcotics, but I guess I could get somebody else to sign those prescriptions." "Uh-uh. I know without asking what the Dean is going to say when he's told about this." Fowler looked at the diver's watch on his wrist. "Which I'm about to do in half an hour."He held up a hand to forestall the words that were on her lips."He's probably going to suggest I suspend you from clinical duties until this is settled." "Suspended?" "Doesn't matter what word you use. Actually, the President would probably suggest that I find a way to terminate you, but that's because he's afraid this might bring some bad publicity to the medical center. The Dean's more realistic and a bit less motivated by perception and politics. Be that as it may, I'm pretty sure Dean Dunston is going to feel it would be good for you to be out of sight until this thing is settled and you're cleared. Anyway, don't worry, because you won't be suspended." She breathed a sigh of relief. "Well, not as such," Fowler said. "Instead, you're going to take a vacation for a while." "But I don't have any vacation time coming," Anna said. "As of this moment, you've suddenly become eligible for a two-week leave for special study and personal enrichment. Don't sweat the paperwork. I can handle that." "What am I supposed to do during this time? And what happens after that?" Fowler tented his fingers. "You're supposed to use that superior intellect that made me hire you to figure out how somebody got hold of your narcotics number and 'script pads and started playing Dr. Feelgood. When you do, take that information to the DEA or the Department of Public Safety or whatever agency has jurisdiction, and clear your name." "What if I can't?" The chairman removed his wire-rimmed glasses and began polishing them with a spotless handkerchief. When he'd finished, he looked directly at her and said in a low voice, "Have you heard the expression, 'failure is not an option?' " "Yes." Fowler nodded once. The silence stretched on for a long moment. Then the chairman turned his attention to the stack of papers in front of him. Anna swallowed hard. "I see." Fowler tented his fingers. "You're supposed to use that superior intellect that made me hire you to figure out how somebody got hold of your narcotics number and 'script pads and started playing Dr. Feelgood. When you do, take that information to the DEA or the Department of Public Safety or whatever agency has jurisdiction, and clear your name." "What if I can't?" The chairman removed his wire-rimmed glasses and began polishing them with a spotless handkerchief. When he'd finished, he looked directly at her and said in a low voice, "Have you heard the expression, 'failure is not an option?' " "Yes." Fowler nodded once. The silence stretched on for a long moment. Then the chairman turned his attention to the stack of papers in front of him. Anna swallowed hard. "I see." As Anna changed clothes in the women's dressing room, she felt the glances of surgical nurses and female physicians burning into her back like live coals. She was sure that everyone at the medical center already knew about the death of her patient. She was willing to bet that by tomorrow they'd be whispering about something else: that she'd been accused of writing bogus narcotics prescriptions. Maybe Dr. Fowler was right. She should get out of here. She pulled out of the faculty garage and started toward home, navigating on automatic pilot. Maybe she'd stop at Blockbuster for a movie to get her mind offher problems. Have a quiet dinner in front of the TV, soak in the tub, try to forget for a few blessed minutes. Then a quick mental review of the contents of her refrigerator changed her route. Better stop by the grocery store as well. Anna wove up and down the aisles of the store with frequent stops to add items, not sure when she'd have time to shop again. Sort of like laying in provisions for a siege, she told herself. On her trip down the second aisle she visited, she noticed the clunking sound and the tendency of the cart to pull to one side like a car with a flat tire. By the time she discovered the malfunction, it seemed easier to battle the balky conveyance than unload her groceries into another one. After all, what was one more inconvenience on top of what had already happened? Surely things couldn't get any worse. At least, she hoped that was the case. When she reached the head of the checkout line, a pimplyfaced clerk with a faint smile on his face but none in his voice began scanning her items. He met her eyes long enough to say, "May I have your Reward Card, ma'am?" Anna found her keys, buried as usual in the deepest, darkest corner of her purse. The clerk thumbed through the plastic tags until he found the right one. He swiped it several times and finally tossed the keys back onto the counter. "The tag's too worn. Won't scan. What's your phone number?" She repeated the number to the clerk while she swept the keys into her purse and transferred the last of the items from her cart onto the moving belt. Whether the clerk's heart was in his work, his hands moved swiftly, and in a moment the items were scanned and bagged. "That's $62.48." Anna had pulled out her wallet along with her keys and was ready with her MasterCard. She swiped it and watched the screen, waiting to confirm the amount and sign. She was still waiting when the clerk said, "Ma'am, swipe it again. I'm getting an error message." She complied. "Ma'am," the clerk said, "there's a problem with your card. Do you want to use another one?" "I only brought this one. What's the matter with it?" "This account is over its limit. Do you want to write a check? Pay with cash?" The impatience in the clerk's voice made Anna glance around. The man behind her was shifting from one foot to the other, and the line was building. "I don't have my checkbook," she said. "And I don't have that much cash. I . . . I'll come back." She didn't even think about the groceries. All she could think about was getting away from the irritable clerk, away from the exasperated looks of the people behind her in line. She screeched out of the parking lot, impatient to get home and call the credit card company. There was no way her card was over its limit. Somebody owed her an explanation.