“When you consider the number of cardiac cases done at the Memorial,” said Thomas, “you must realize how insignificant a percentage you’re talking about. The Memorial’s death rate is not only well below the average, it’s equal to the best.”

“I also know that,” said Cassi. “But still it’s fascinating when you consider the trend.”

Thomas suddenly took Cassi’s arm. “Listen, it’s bad enough that you chose psychiatry as a specialty, but don’t try embarrassing the surgical department about our failures. We are aware of our mistakes. That’s why we have a death conference.”

“I never intended to cause you embarrassment,” said Cassi. “Besides, the SSD study is Robert’s. I told him today that he was going to have to carry on without me. I just think it’s fascinating.”

“The competitive climate of medicine always makes other people’s mistakes fascinating,” said Thomas, gently propelling Cassi through the archway into the dining room, “whether they are legitimate mistakes or acts of God.”

Cassi felt a pang of guilt as she thought about the truth of Thomas’s last statement. She never considered it that way, but it was true.

As they entered the dining room, Harriet gave them a petulant glance and said that they were late.

Thomas’s mother was already seated at the table. “It’s about time you two showed up,” she said in her strong, raspy voice. “I’m an old woman. I can’t go this long before dinner.”

“Why didn’t you eat earlier?” said Thomas, taking his chair.

“I’ve been by myself for two days,” complained Patricia. “I need some human contact.”

“So I’m not human, am I?” said Harriet with annoyance. “The truth has finally come out.”

“You know what I mean, Harriet,” said Patricia with a wave of her hand.

Harriet rolled her eyes and began serving the casserole.

“Thomas, when are you going to get that hair of yours cut?” said Patricia.

“As soon as I have a little extra time,” said Thomas.

“And how many times do I have to tell you to put your napkin on your lap,” said Patricia.

Thomas pulled the napkin from the silver holder and threw it onto his lap.

Mrs. Kingsley placed a minute amount of food in her mouth and began chewing. Her bright blue eyes, similar to Thomas’s, ranged around the table, following Harriet’s progress, waiting for the slightest slip-up. Patricia was a pleasant-looking, white-haired lady with a will of iron. She had smoked Lucky Strikes for years and had deep creases running from her mouth like spokes on a wheel. She was obviously lonely, and Cassi continually wondered why the woman didn’t move to some place where she’d have friends her own age. Cassi knew the thought was motivated by her own interests. After more than three years of eating almost every evening meal with Patricia, Cassi longed for a more romantic end to the day. Despite Cassi’s strong feelings in this regard, she never said anything. The truth of the matter was that Cassi had always been intimidated by this woman, and she’d been reluctant to offend her and thereby incur Thomas’s wrath.

Still and all, Cassi got along passingly well with Mrs. Kingsley, at least from Cassi’s perspective, and she did feel sorry for the woman, living in the middle of nowhere over her son’s garage.

After Harriet served, the dinner proceeded in silence, punctuated by silver clanking against china and whispered negatives to Harriet who tried to force seconds on everyone. It wasn’t until they were almost finished that Thomas broke the silence: “My surgeries went well today.”

“I don’t want to hear about death and disease,” said Mrs. Kingsley. Then she turned to Cassandra and said, “Thomas is just like his father, always wanting to discuss his business. Never could talk about anything important or cultural. Sometimes I think I would have been better off if I’d never married.”

“You can’t mean that,” said Cassi. “Otherwise you wouldn’t have such an extraordinary son.”

“Ha!” said Patricia with explosive suddenness. Her laugh echoed in the room, making the Waterford candelabra vibrate. “The only thing truly extraordinary about Thomas is how closely he resembles his father, even to having been born with a clubfoot.”

Cassi dropped her fork. Thomas had never mentioned this. The image of him as a tiny baby with a twisted foot triggered a wave of sympathy in Cassi, but it was clear from his expression that Thomas was furious with his mother’s revelation.

“He was a wonderful baby,” continued Patricia, oblivious to her son’s barely suppressed rage. “And a handsome, wonderful child. At least until puberty.”

“Mother,” said Thomas in a slow, even voice. “I think you’ve said enough.”

“Fiddlesticks, as they used to say,” returned Patricia. “It’s your turn to be quiet. I’ve been alone here, except for Harriet, for two days, and I should be able to talk.”

With a final glance of exasperation, Thomas bent over his food.

“Thomas,” called Patricia after a short silence. “Please remove your elbows from the table.”

Thomas pushed back his chair and stood up, his face flushed. Without a word, he threw down his napkin and left the room. Cassi heard him stomping upstairs. Then the door to his study slammed. The Waterford candelabra again tinkled gently.

Caught in the middle, as usual, Cassi hesitated, not knowing what was the best thing for her to do. After a moment of indecision she too stood up, planning on following Thomas.

“Cassandra,” said Patricia sharply. Then in a more plaintive voice she said, “Please sit down. Let the child be. Eat. I know people with diabetes have to eat.”

Flustered, Cassi sat down.

Thomas paced his study, mumbling out loud that it was unfair that he should have to weather such abuse at home after his frustrating day at the hospital. Angrily he wondered why Cassi had stayed with his mother instead of joining him. For a moment he considered returning to the hospital, fantasizing about Mr. Campbell’s daughter and the respect that she would be willing to show him. He remembered her comment about wishing there was something she could do for him.

But the cold rain beating on the window made the idea of returning to town seem like too much effort. Instead he picked up the journal from the top of his towering pile of reading and sprawled in the burgundy leather armchair next to the fireplace.

Trying to read, Thomas found his mind wandering. He wondered why his mother could still, after all these years, irritate him so easily. Then Thomas thought about Cassi and the SSD series that she’d been helping Robert Seibert with. There was no doubt in his mind that the kind of publicity that such a study would generate would be extraordinarily detrimental to the hospital. He also knew that Robert just wanted to get his name in print. He didn’t care who he hurt.

Thomas threw the unread journal to the side and went into the bathroom off the study. Staring into the mirror, he looked at his eyes. He’d always thought he looked young for his age, but now he was not quite so sure. There were dark circles under his eyes, and the lids seemed red and swollen.

Returning to his study, he sat at his desk and opened the second drawer on the right, removing a plastic bottle. He popped a yellow pill into his mouth and, after a brief hesitation, another. Over at the bar he poured himself a single-malt whiskey and sat down in the leather armchair that had been his father’s. He already felt a lessening of his tension. Reaching over to the side table, he picked up the journal again and tried to read.

But he couldn’t concentrate. He still felt too much anger. His mind went back to his first week as the chief cardiac surgery resident when he’d been faced with a full intensive care unit and two senior attendings who were demanding space. Without empty available beds, the whole surgical schedule came to a halt.