She put the innocent pill down on the desk and returned the PDR to the shelf. For a moment she was sorry she’d gone into Thomas’s study and found the pill. It would have been easier to ignore the situation. After all, it was most likely a temporary problem, and if she said something to Thomas, he would only get angry.

“You’ve got to do something,” said Cassi, trying to build her resolve. As ridiculous as it seemed, the only person who exerted any kind of authority over Thomas’s life was Patricia. Although Cassi was reluctant to discuss the issue with anyone, at least she could expect Patricia to keep Thomas’s best interests at heart. Briefly weighing the advantages and disadvantages, she decided to discuss the situation with her mother-in-law. If Thomas had been abusing Dexedrine for a long time, someone should intervene.

The first thing she had to do, Cassi decided, was to make herself presentable. Pulling off her terry robe and her nightgown, she went to the shower.

Thomas enjoyed presenting cases at Grand Rounds. The entire departments of internal medicine and surgery attended, including residents and medical students. Today the MacPherson amphitheater was so full people had even been forced to sit on the steps leading up from the central pit. Thomas always drew a crowd even when, as today, he split the schedule with George.

As Thomas finished his talk, which had been titled “Long-Term Follow-Up of Patients Undergoing Coronary Bypass,” the entire amphitheater broke into enthusiastic applause. The sheer volume of Thomas’s work was enough to impress anyone, and given his good results, the statistics seemed superhuman.

When he opened up the floor for questions, someone from the upper tier yelled out that he’d like to know what kind of diet Thomas ate that gave him so much energy. The audience laughed heartily, eager for a morsel of humor.

When the laughter died down, Thomas concluded by saying: “I believe from the statistics I’ve presented there can no longer be any residual doubt as to the efficacy of the coronary bypass procedure.”

He gathered his papers and took a chair at the table behind the podium next to Dr. George Sherman.

The topic of George’s presentation was “An Interesting Teaching Case.”

Thomas inwardly groaned and glanced longingly at the exit. He had a splitting headache that had gotten progressively more intense after his arrival at the hospital. What a ridiculous topic, Thomas thought. He watched with mounting irritation as George made his way over to the podium and blew into the microphone to make sure it was on. As if that weren’t enough, he tapped it with his ring. Satisfied, he began to speak.

The case was a twenty-eight-year-old man by the name of Jeoffry Washington who’d contracted acute rheumatic fever at age ten. He’d been a sick child at the time and hospitalized for an extended period. When the acute disease had run its course, the child had been left with a loud holosystolic heart murmur, indicating his mitral valve had been severely damaged. Over the years the problem gradually worsened to the point that an operation was needed to replace the damaged valve.

At that point Jeoffry Washington was wheeled in and presented to the audience. He was a slight, callow-appearing Negro with angular, precise features, bright eyes, and skin the color of blond oak. He held his head back and stared up into the multitude of faces that were looking down at him.

As Jeoffry was wheeled back out, Thomas’s and Jeoffry’s eyes happened to meet. Jeoffry nodded and smiled. Thomas returned the gesture. Thomas couldn’t help feeling sorry for the young man. Yet as tragic as his story was it was also quite common. Thomas had personally operated on hundreds of patients with similar histories.

With Jeoffry gone, George returned to the podium. “Mr. Washington has been scheduled to have a mitral valve replacement, but during the work-up an interesting fact was uncovered. Mr. Washington had an episode of pneumocystic carini pneumonia one year ago.”

An excited murmur rippled through the audience.

“I suppose,” called George over the babble of voices, “that it is not necessary to remind you that such an illness suggested AIDS, or Acquired Immune Deficiency Syndrome, which was indeed found in this patient. As it turns out, Jeoffry Washington’s sexual preferences have placed him in that group of homosexual men whose life-style has apparently led to immuno-suppression.”

Thomas now knew what George had meant by his comment in the surgical lounge the previous afternoon. He closed his eyes and tried to control his rising anger. Obviously Jeoffry Washington was an example of the kind of case that was taking OR slots and cardiac surgical beds away from Thomas’s patients. Thomas was not alone in his reservations concerning operating on Jeoffry. One of the internists raised his hand and George recognized him. “I would seriously question the rationale for elective heart surgery in light of the patient’s having AIDS,” said the internist.

“That’s a good point,” said George. “I can say that Mr. Washington’s immunological picture is not grossly abnormal at present. He’s scheduled for surgery next week, but we will be following his helper T-cell and cytotoxic T-cell populations for any sudden decline. Dr. Sorenson of the department of immunology does not think the AIDS is an absolute contraindication for surgery at this time.”

A number of hands popped up in the audience, and George began to call on them. The animated discussion took the conference over its normal time, and even after it was officially over, groups of people stood in clumps to continue talking.

Thomas tried to leave immediately, but Ballantine had gotten up and blocked his way. “Good conference,” he beamed.

Thomas nodded. All he wanted to do was get away. His head felt as if it were in a vise.

George Sherman came up behind Thomas and clapped him on the back. “You and I really entertained them this morning. We should have charged admission.”

Thomas slowly turned to face George’s smiling, self-satisfied face. “To tell you the honest truth, I think the conference was a goddamn farce.”

There was an uncomfortable silence as the two men eyed one another in the midst of the crowd.

“Okay,” said George at length. “I suppose you are entitled to your opinion.”

“Tell me. Is this poor fellow, Jeoffry Washington, whom you paraded out here like some freak, occupying a cardiac surgical bed?”

“Of course,” said George, his own ire rising. “Where do you think he’d be, in the cafeteria?”

“All right, you two,” said Ballantine.

“I’ll tell you where he should be,” snapped Thomas while he jabbed George in the chest with his index finger. “He should be on the medical floor in case something can be done about his immunological problem. Having already had pneumocystic carini pneumonia there’s a good chance he’ll be dead before he ever gets into a life-threatening cardiac state.”

George knocked Thomas’s hand aside. “As I said, you’re entitled to your opinion. I happen to think Mr. Jeoffry Washington is a good teaching case.”

“Good teaching case,” scoffed Thomas. “The man is medically ill. He should not be taking up a scarce cardiac surgical bed. The bed is needed for others. Can’t you understand that? It’s for this kind of nonsense that I have to keep my patients waiting, patients with no medical problems, patients who will be making real contributions to society.”

George again knocked Thomas’s hand away. “Don’t touch me like that,” he snapped.

“Gentlemen,” said Ballantine, stepping between them.

“I’m not sure Thomas knows what the word means,” said George.

“Listen, you little shithead,” snarled Thomas, reaching around Ballantine and grabbing a handful of George’s shirt. “You’re making a mockery of our program with the cases you’re dredging up just to keep the so-called teaching schedule full.”