When Thomas entered the room, which was tastefully decorated with pale blue walls and white trim, his attention was caught by an emotional outburst in the corner.

“Why, why?” shouted a small, distraught woman.

“There, there,” said Dr. George Sherman, trying to calm the sobbing woman. “I’m sure they did all they could to save Sam. We knew his heart was not normal. It could have happened at any time.”

“But he’d been happy at the home. We should have let him be. Why did I let you talk me into bringing him here. You told me there was some risk if you operated. You never told me there was a risk during the catheterization. Oh God.”

The woman’s tears overwhelmed her. She began to sag, and Dr. Sherman reached out to catch her arm.

Thomas rushed over to George’s side and helped support the woman. He exchanged glances with George, who rolled his eyes at the outburst. As a member of the full-time cardiac staff, Thomas did not have a high regard for Dr. George Sherman, but under the circumstances he felt obligated to lend a hand. Together they sat the bereaved mother down. She buried her face in her hands, her hunched-over shoulders jerking as she continued to sob.

“Her son arrested down in X ray during a catheterization,” whispered George. “He was badly retarded and had physical problems as well.”

Before Thomas could respond, a priest and another man, who was apparently the woman’s husband, arrived. They all embraced, which seemed to give the woman renewed strength. Together they hurriedly left the room.

George straightened up. It was obvious that the situation had unnerved him. Thomas felt like repeating the woman’s question about why the child had been taken from the institution where he’d apparently been happy, but he didn’t have the heart.

“What a way to make a living,” said George self-consciously as he left the room.

Thomas scanned the faces of the people remaining. They were looking at him with a mixture of empathy and fear. All of them had family members currently undergoing surgery, and such a scene was extremely disquieting. Thomas looked for Campbell’s daughter. She was sitting by the window, pale and expectant, arms on her knees, hands clasped. Thomas walked over to her and looked down. He’d seen her once before in his office and knew her name was Laura. She was a handsome woman, probably about thirty, with fine light brown hair pulled back from her forehead in a long ponytail.

“The case went fine,” he said gently.

In response, Laura leaped to her feet and threw herself at Thomas, pressing herself against him and flinging her arms around his neck. “Thank you,” she said, bursting into tears. “Thank you.”

Thomas stood stiffly, absorbing the display of emotion. Her outburst had taken him by complete surprise. He realized that other people were watching and tried to disengage himself, but Laura refused to let go. Thomas remembered that after his first open-heart success, Mr. Nazzaro’s family had been equally hysterical in their thanks. At that time Thomas had shared their happiness. The whole family had hugged him and Thomas had hugged them back. He could sense the respect and gratitude they felt toward him. It had been an unbelievably heady experience, and Thomas recalled the event with strong nostalgia. Now he knew his reactions were more complicated. He often did three to five cases a day. More often than not he knew little or nothing about his patients save for their preoperative physiological data. Mr. Campbell was a good example.

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

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

Reaching up, he detached Laura’s encircling arms.

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

She nodded, suddenly embarrassed by her behavior.

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

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

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

“Thanks for the help in the waiting room.”

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

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

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

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

Thomas slowly lowered his paper again.

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

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

“I was aware of it,” said Thomas.

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

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

“It should be,” said George.

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

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

“I can’t wait,” said Thomas.

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

Thomas watched the man saunter away from him. It annoyed him to be touched and pummeled like that. It seemed so juvenile. While he watched, George joined a group of residents and scrub nurses slumped over several chairs near the window. Laughter and raised voices drifted across the room. The truth was that Thomas could not stand George Sherman. He was convinced George was a man bent on accumulating the trappings of success to cover a basic mediocrity in surgical skill. It was all too familiar to Thomas. One of the seemingly inadvertent evils of the academic medical center was that appointments were more political than anything else. And George was political. He was quick-witted, a good conversationalist, and socialized easily. Most important, he thrived within the bureaucratic committee system of hospital politics. He’d learned early that for success it was more important to study Machiavelli than Halstead.