Eleven years later she returned to the D. C. area as a board eligible internist and was shocked to learn that Duncan Lathram was no longer the gung-ho, life-saving surgical whirlwind she had left behind, somehow he had metamorphosed into a cosmetic surgeon who devoted his abbreviated workdays to prettifying the rich and powerful of Washington society.

From gonzo to dilettante, or something close to a dilettante. What had happened during those seven years? Gin had tried to piece it together but got nowhere. No one who knew was talking. Only Gin seemed to care. Something was missing. Duncan used to fight bleeders, now he fought wrinkles. If he'd been specializing in tummy tucks instead of vascular repair nineteen years ago, she might not be here today. So Gin's perspective differed from all the youth-chasing ninnies who flocked to Duncan to help them turn back the clock. They worshiped this man who could help them escape the unsightly dues that nature , nurture, genetics, and lifestyle demanded they pay.

Duncan had become someone else's god.

"Morning, Gin, " said a voice behind her.

Over her shoulder she saw Duncan's younger brother Oliver delivering a sterile tray of implants to the OR. He smiled and waved as he passed.

If Duncan was a rack of baby-backs, Oliver was a roast beef, rounder, heavier, with thinning hair, thick hornrimmed glasses, and a protective layer of fat. Also softer, gentler, far more easygoing than his older brother. A sweetheart. He made sure all the women on the staff received flowers on their birthday. And when Joanna's son got arrested for joyriding, Oliver was there to bail him out. Everybody loved him.

Gin rinsed, shook, and entered OR-1 just as Marie, the nurse anesthetist, said, "He's out." Gin took in OR-1 as Marie tied her mask and Joanna helped gown and glove her. Smaller than anything at Tulane, but the skill and professionalism here could hold their own against any tertiary medical center. Odorless, the laminar airflow kept it that way, and cold. Duncan liked to work under almost arctic conditions.

She approached the table where a middle-aged man, fiftyish or so, lay supine, his face covered except for the lips, chin, and throat, which were prepped for surgery. He looked something other than human with his skin stained yellow brown from the Betadine and his chin and throat marked up with the lines Duncan had drawn to guide his surgery.

Gin had met him last week when she'd done his pre-op history and physical, Senator Harold Vincent. Another member of the recently revived joint committee.

Like Congressman Allard.

She was struck by the coincidence, but only for a moment. Hell, half of Washington's officials or their wives had been Duncan's patients at one time or another since he'd started in plastic surgery, and the other half probably were on the waiting list. Not surprising, really.

His technical skills were second to none and he saw to it that people who considered themselves V.I.Ps were treated accordingly, they got absolute discretion, and, thanks to his brother, he had exclusive use of an innovative technique that halved the healing time greatly reduced.

"Ready to begin, Gin? " Duncan said. "The senator is getting impatient.

He's got a bunch of lobbyists camped out in his office with pockets full of cash. We don't want to keep them waiting, do we? " Joanna tittered behind her mask.

Duncan made his first incision under the chin, carefully following the natural lines of cleavage, then began the delicate task of dissecting away and trimming off portions of the stretched muscle, the platysma, that gave the senator's neck a sagging, aged look. Senatot Vincent had a particularly large amount of excess tissue, giving him a Tom-turkey wattle that fluttered when he spoke and flapped back and forth when he walked.

"Senator Impatience here couldn't wait, " Duncan said as he worked.

"An emergency, he told me. Had to have it immediately. Any one care to guess what the emergency is? " "Has to be TV, " Marie said from her spot at the top of the senator's head.

"Bingo. Give that woman a cigar." Marie didn't miss a beat, "Not while the o2 is running, thank you."

"It's the Joint Committee on Medical Ethics and Practice Guidelines, of course, " Duncan said.

Gin stifled a groan. Here we go again. The joint committee was on Duncan's Permanently-Ticks-Me-Off list. He hated it and everything it was set up to do. He could go on for hours. Today the subject was a particularly uncomfortable one for Gin, what with no word from Senator Marsden's office, and her pending interview with Congressman Allard tomorrow.

"I've seen Senator Vincent on TV plenty of times, " Gin said, sponging the blood that began pooling in the incision.

"Sure. C-SPAN. But who besides you and I watches CSPAN? This boy has his eye on a much larger audience. Suction. Daily sound and video bites for all the network news shows, even looking for some live prime-time coverage. And our self-styled Champion of the Working Person' wants to look pretty for the nation. Clamp." Gin glanced at Joanna who rolled her dark eyes as she slapped the handles of the clamp into Duncan's gloved palm. He' olf to the races.

All right, so Duncan had a few fixations. Everybody had one or two.

His just happened to be the Old-Boy network in the federal government and its intrusion into the practice of medicine. But even from his ramblings you could learn something.

"Some champion, " he continued. "Voted himself a thirty-one-thousand-dollar pay raise during the recession, not to mention a government-issued Diners Club Card. Hand me the curved hemostat. That's the one. Here he is, vocal supporter of the Equal Pay Act, the Age Discrimination in Employment Act, the Occupational Health and Safety Act, and the National Labor Relations Act, as he'll remind you at every opportunity. But what he doesn't say is that behind closed doors he voted to keep the U. S. Senate exempt from all those acts. Suction." He was silent as he made another incision.

Gin continued to marvel at the grace and precision of his scalpel work.

He made it look so easy.

Gin knew it was anything but.

"But I'm thankful I'm only his plastic surgeon. Can you imagine being his proctologist? " He looked up and winked at her. "I mean, where to begin? ' Marie guffawed.

"As always, ' Duncan said, "laws imposed to assure fair play among the constituency do not apply to the kakistoc . .

racy.

Gin didn't want to, but felt compelled to ask. "All right, I give up.

What's this kakistocracy you're always talking about? I can't find it in the dictionary. ' "You won't unless you use an unabridged edition.

The kakistocracy reflects the anomie of our times."

"Oh, that helps a lot." '"It is rulership by the worst." Perfect time to spring one of my own words for the day, Gin thought.

'"I guess then you might say that the members of the kakistocracy excel at casuistry." She saw Duncan smile behind his mask. "Very good! " Marie turned to Joanna. "Great. Now neither of them are speaking English." Gin said, "I'm merely participating in the lingua franca.

' Two! she thought. I got two of them in! Duncan's eyes sparkled as he turned to Marie and Joanna. "Casuistry is the rationalization of matters of conscience, but I wonder if we can presume that the Senator Vincents of the world even have a conscience.

' He held out a gloved hand. "The implant, Gin. Time's a-wasting. " '"Oh sure. Sorry." Joanna uncovered the sterile tray, revealing the implants, tiny cylinders, soft, shiny, and slightly curved, looking like sausages or hot dogs. Hot dogs for a Barbie Doll. They came in all sizes. These on the tray were the mediums, twenty millimeters long, maybe five millimeters in diameter, each filled with Oliver's "secret sauce, " an enzyme solution that promoted healing, reduced edema, and retarded scar formation.