Luz felt she had no choice but to accept this. She met the doctor's eyes for a long moment, then nodded mechanically and thanked her. Then she and her bundled-up and shivering son were back out in the cold and terrible night.

At around 6:20 on the morning of Tuesday, April 10, a forty-seven-year-old businessman named Tim Markham was on the last leg of his customary jog. Every weekday when he wasn't traveling, Markham would run out the driveway of his mansion on McLaren within minutes on either side of 5:45. He would turn right and then right again on Twenty-eighth Avenue, jog down to Geary, go left nearly a mile to Park Presidio, then left again back up to Lake. At Twenty-fifth, he'd jog a block right to Scenic Way, cut down Twenty-sixth, and finally turn back home on Seacliff where it ran above Phelan Beach.

In almost no other ways was Markham a creature of habit, but he rarely varied either the route of his run or the time he took it. This morning-garbage day in the neighborhood-he was struck by a car in the intersection just after he left the sidewalk making the turn from Scenic to Twenty-sixth. The impact threw him against one of the trash receptacles at the curb and covered him in refuse.

Markham had been jogging without his wallet and hence without benefit of identification. Although he was a white man in physically good health, he hadn't yet shaved this morning. The combination of the garbage surrounding him with his one-day growth of beard, his worn-down running shoes, and the old sweats and ski cap he wore made it possible to conclude that he was a homeless man who'd wandered into the upscale neighborhood.

When the paramedics arrived from the nearby fire station, they went right to work on him. Markham was bleeding from severe head trauma, maybe had punctured and collapsed a lung. He'd obviously broken several bones including his femur. If this break had cut an artery, it was a life-threatening injury all by itself. He would clearly need some blood transfusions and other serious trauma intervention immediately if he were going to have a chance to survive.

The ambulance driver, Adam Lipinski, was a longtime veteran of similar scenes. Although the nearest emergency room was at Portola Hospital, twenty blocks away in the inner Richmond District, he knew both from rumor and personal experience that Portola was in an embattled financial state right now. Because it was forbidden by law to do otherwise, any hospital would have to take this victim into the ER and try to stabilize him somewhat. But if he was in fact homeless and uninsured, as Lipinski suspected, there was no way that Portola would then admit him into the hospital proper.

Lipinski wasn't a doctor, but he'd seen a lot of death and knew what the approach of it could look like, and he was thinking that this was one of those cases. After whatever treatment he got in the ER, this guy was going to need a stretch in intensive care, but if he didn't have insurance, Lipinski was all but certain that Portola would find a way to declare him fit to move and turf him out to County.

Last month, the hospital had rather notoriously transferred a day-old baby-a baby!-to County General after she'd been delivered by emergency C-section in the ER at Portola in the middle of the night, six weeks premature and addicted to crack cocaine. The mother, of course, had no insurance at all. Though some saint of a doctor, taking advantage of the administration's beauty sleep, had simply ordered the baby admitted to Portola's ICU, by the next day someone had decided that the mother and child couldn't pay and therefore had to go to County.

Some Portola doctors made a stink, arguing that they couldn't transfer the mother so soon after the difficult surgery and birth-she was still in grave condition and transporting her might kill her, and the administration had backed down. But it countered that the baby, Emily, crack addiction and all, would clearly survive the trip across town. She would be transferred out. Separated from her mother within a day of her birth.

At County General, Emily had barely held on to life for a day in the overcrowded special unit for preemies. Then Jeff Elliot's "CityTalk" column in the Chronicle had gotten wind of the outrage and embarrassed Portola into relenting. If not for that, Lipinski knew that the poor little girl probably wouldn't have made it through her first week. As it was, she got readmitted to Portola's ICU, where she stayed until her mother left ten days later, and where the two of them ran up a bill of something like seventy thousand dollars. And all the while politicos, newspaper people, and half the occupants of their housing project-whom the administration accused of stealing drugs and anything else that wasn't tied down-generally disrupted the order and harmony of the hospital.

In the wake of that, Portola put the word out-this kind of admitting mistake wasn't going to happen again. Lipinski knew beyond a doubt that once today's victim was minimally stabilized, Portola would pack him back up in an ambulance and have him taken to County, where they had to admit everybody, even and especially the uninsured. Lipinski wasn't sure that the victim here would survive that second trip and even if he did, the ICU at County was a disaster area, with no beds for half the people who needed them, with gurneys lining the halls.

But there was still time before he had to make that decision. The paramedics were trying to get his patient on a backboard, and the police had several officers knocking on doors and talking to people in the crowd that had gathered to see if anyone could identify the victim. Even rich people, snug in their castles, unknown to their neighbors, might recognize the neighborhood bum.

Because the body was so broken, it took longer than he'd originally estimated, but eventually they got the victim hooked up and into the back. In the meantime, Lipinski had decided that he was going directly to County. Portola would just screw around too much with this guy, and Lipinski didn't think he'd survive it. He'd just shifted into gear and was preparing to pull out when he noticed a couple of cops running up with a distraught woman in tow.

He knew what this was. Shifting back into park, he left the motor running, opened his door, and stepped out into the street. As the cops got to him, he was ready at the back door, pulling it open. Half walking, half running, the woman was a few steps behind them. She stepped up inside and Lipinski saw her body stiffen, her hands come up to cover her mouth. "Oh God," he heard. "Oh God."

He couldn't wait any longer. Slamming the door shut behind her, he ran back and hopped into his seat. They had their identification. And he was going to Portola.