“I’m passing a transvenous pacemaker,” said Jerry, shocked and impressed by Dr. Kingsley’s presence. Staff members usually did not respond to cardiac arrests, especially in the middle of the night.

“Looks like total cardiac standstill,” said Dr. Kingsley, running a portion of the voluminous EKG tape through his hands. “No evidence of any type of AV block. The chance of a transvenous pacemaker being successful is infinitesimally small. I think you’re wasting your time.” Dr. Kingsley then felt for a pulse at Bruce’s groin. Glancing up at Peter, who was perspiring by this time, Dr. Kingsley said, “Pulse is strong. You must be doing a good job.” Turning to Pamela he said: “Size eights, please.”

Pamela produced the gloves without delay. Dr. Kingsley pulled them on and asked for the crash cart scalpel.

“Could you pull off the dressing?” said Dr. Kingsley to Peter. To Pamela he said he needed some sterile heavy dressing scissors.

Peter glanced at Jerry for confirmation, then paused in his massage, and pulled off the tangle of adhesive and gauze over the patient’s sternum. Dr. Kingsley stepped up to the bed and fingered the scalpel. Without further delay he buried the tip of the knife in the top of the healing wound and decisively drew it down to the base. There was an audible snap as he cut each of the translucent blue nylon sutures. Peter slid off the bed to get out of the way.

“Scissors,” said Dr. Kingsley calmly as his audience watched in shocked silence. This was the kind of scene they’d read about but had never seen.

Dr. Kingsley snipped through the wire sutures holding the split sternum together. Then he pushed both hands into the wound and forcibly pulled the sternum apart. There was a sharp cracking noise. Jerry Donovan tried to glance into Bruce’s chest but Dr. Kingsley had obscured the view. The one thing Jerry could tell was that there was no bleeding whatsoever.

Dr. Kingsley eased his hand, fingers first, into Bruce’s chest and cupped the apex of the heart. Rhythmically he began to compress it, nodding to Rose when she should inflate the lungs. “Check the pulse now,” said Dr. Kingsley.

Peter dutifully stepped forward. “Strong,” he said.

“I’d like some epinephrine, please,” said Dr. Kingsley. “But it doesn’t look good. I think this patient arrested some time ago.”

Jerry Donovan thought about saying he had the same impression but decided against it.

“Call the EEG lab,” said Dr. Kingsley, continuing to massage the heart. “Let’s see if there’s any brain activity at all.”

Trudy went to the phone.

Dr. Kingsley injected the epinephrine but could see that there was no effect on the EKG. “Whose patient is this?” he asked.

“Dr. Ballantine’s,” said Pamela.

Bending over, Dr. Kingsley peered into the wound. Jerry guessed he was assessing the surgical repair. It was common hospital knowledge that on a scale of one to ten, as far as operative technique was concerned, Kingsley was a ten, and Ballantine, despite the fact that he was chief of the cardiac surgery department, was about a three.

Dr. Kingsley abruptly looked up and stared at the medical student as if he’d seen him for the first time. “How can you tell at the moment this isn’t a case of an AV block, Doctor?”

All color drained from the student’s face. “I don’t know,” he managed finally.

“Safe answer,” smiled Dr. Kingsley. “I wish I had had the courage to admit not knowing something when I was a medical student.” Turning to Jerry he asked: “What are his pupils doing?”

Jerry moved over and lifted Bruce’s eyelids. “Haven’t budged.”

“Run in another amp of bicarbonate,” ordered Dr. Kingsley. “I assume you gave some calcium.”

Jerry nodded.

For the next few minutes there was silence as Dr. Kingsley massaged the heart. Then a technician appeared at the doorway with an ancient EEG machine.

“I just want to know if there’s any electrical activity in the brain,” said Dr. Kingsley. The technician attached the scalp electrodes and turned on the machine. The brain wave tracings were flat, just like the EKG.

“Unfortunately, that’s that,” said Dr. Kingsley as he withdrew his hand from Bruce’s chest and stripped off his gloves. “I think someone better call Dr. Ballantine. Thank you for your help.” He strode from the room.

For a moment no one spoke or moved. The EEG technician was first. Self-consciously he said he’d better get back to the lab. He unhooked his paraphernalia and left.

“I’ve never seen anything like that,” said Peter, staring at Bruce’s gaping chest.

“Me neither,” agreed Jerry. “Kinda takes your breath away.”

Both men stepped up to the bed and peered into the wound.

Jerry cleared his throat. “I don’t know what you need more, competence or self-confidence, to cut into someone like that.”

“Both,” said Pamela, pulling the plug on the EKG machine. “How about you fellows giving us some room to get this place in order. By the way, one thing I forgot to mention. When I found Mr. Wilkinson, his IV was running rapidly. It should have been barely open.” Pamela shrugged. “I don’t know if it was important or not but I thought I’d let you know.”

“Thanks,” said Jerry absently. He wasn’t listening. Daintily he stuck his index finger into the wound and touched Bruce’s heart. “People say Dr. Kingsley is an arrogant son of a bitch, but there is one thing I know for sure. If I needed a bypass tomorrow, he is the one I’d have do it.”

“Amen,” said Pamela, pushing her way between Jerry and the bed to begin preparation of the body.

“There was one new admission last night,” said Cassandra Kingsley, glancing down at her preliminary work-up. She felt distinctly ill at ease, having been thrust into the spotlight of the early morning team meeting on the psychiatry ward, Clarkson Two. “His name is Colonel William Bentworth. He’s a forty-eight-year-old Caucasian male, thrice divorced, who’d been admitted through the ER after an altercation in a gay bar. He was acutely intoxicated and abusive to the ER personnel.”

“My God!” laughed Jacob Levine, the chief psychiatric resident. He took off his round, wire-rimmed glasses and rubbed his eyes. “Your first night on psychiatry call and you get Bentworth!”

“Trial by fire,” said Roxane Jefferson, the black, no-nonsense head nurse for Clarkson Two. “No one can say psychiatry at the Boston Memorial is a boring rotation.”

“He wasn’t my idea of a perfect patient,” admitted Cassi with a weak smile. Jacob’s and Roxane’s comments made her feel a bit more relaxed, sensing that if she made an ass of herself with her presentation, everyone would excuse her. Bentworth was no foreigner to Clarkson Two.

Cassi had been a psychiatry resident for less than a week. November wasn’t the usual time for people to begin a residency, but Cassi had not decided to switch from pathology to psychiatry until after the beginning of the medical year in July and had only been able to do so because one of the first-year residents had quit. At the time Cassi thought she’d been extraordinarily lucky. But now she wasn’t so sure. Starting a residency without other colleagues equally as inexperienced was more difficult than she’d anticipated. The other first-year residents had almost a five-month jump on her.

“I bet Bentworth had some choice words for you when you showed up,” sympathized Joan Widiker, a third-year resident who was currently running the psychiatric consultation service and who had taken an immediate liking to Cassi.

“I wouldn’t want to repeat them,” admitted Cassi, nodding toward Joan. “In fact he refused to talk with me at all, other than to tell me what he thought of psychiatry and psychiatrists. He did ask for a cigarette, which I gave him, thinking it might relax him, but instead of smoking it he proceeded to press the lighted end against his arms. Before I could get some help, he’d burned himself in six places.”