Cardiomyopathy,” said Dr. Gupta.

He sat with Ryan not in an examination room but in his private office, as though he felt the need to deliver this news in a less clinical, more reassuring environment.

On a shelf behind the desk, in silver frames, were photos of the physician’s family. His wife was lovely. They had two daughters and a son, all good-looking kids, and a golden retriever.

Also on the shelf stood a model of a sailboat, and two photos of the Gupta family-dog included-taken aboard the real vessel.

Listening to his diagnosis, Ryan Perry envied the cardiologist for his family and for the evident richness of his life, which was a blessing quite different from-and superior to-riches.

“A disease of the heart muscle,” said Samar Gupta. “It causes a reduction in the force of contractions, a decrease in the efficiency of circulation.”

Ryan wanted to ask about cause, the possibility of poisoning that Forry Stafford had mentioned, but he waited.

Dr. Gupta’s diction was as precise as ever, but the musicality of his voice was tempered now by a compassion that imposed on him a measured solemnity: “Cardiomyopathies fall into three main groups-restrictive cardiomyopathy, dilated, and hypertrophic.”

“Hypertrophic. That’s the kind I’ve got.”

“Yes. An abnormality of heart-muscle fibers. The heart cells themselves do not function properly.”

“And the cause?”

“Usually it’s an inherited disorder.”

“My parents don’t have it.”

“Perhaps a grandparent. Sometimes there are no symptoms, just sudden death, and it’s simply labeled a heart attack.”

Ryan’s paternal grandfather had died of a sudden heart attack at forty-six.

“What’s the treatment?”

The cardiologist seemed embarrassed to say, “It is incurable,” as if medical science’s failure to identify a cure was his personal failure.

Ryan focused on the golden retriever in the family portrait. He had long wanted a dog. He’d been too busy to make room for one in his life. There had always seemed to be plenty of time for a dog in the years to come.

“We can only treat the symptoms with diuretic drugs to control heart failure,” said Dr. Gupta, “and antiarrhythmic drugs to control abnormal rhythms.”

“I surf. I lead a fairly vigorous life. What restrictions are there going to be, how will things change?”

The cardiologist’s hesitation caused Ryan to look away from the golden retriever.

“The primary issue,” said Dr. Gupta, “is not how restricted your life will be…but how long.”

In the physician’s gentle eyes, as in a fortuneteller’s sphere, Ryan saw his future.

“Your condition is not static, Ryan. The symptoms…they can be ameliorated, but the underlying disease is not arrestable. Heart function will steadily deteriorate.”

“How long?”

Dr. Gupta looked away from Ryan, at another photo of his family that stood on his desk. “I think…no more than a year.”

Wednesday night, writhing in pain on the floor of his bedroom, Ryan had expected to die right there, right then. In the days since, he had anticipated being felled at any moment.

A year should, therefore, have seemed like a gift, but instead the prognosis was a psychic guillotine that cut through him, and his anguish was so intense that he could not speak.

“I could tell you about advances in adult stem-cell research,” said Dr. Gupta, “but there’s nothing coming within a year, perhaps nothing ever, and you aren’t a man who would take comfort in such wishful thinking. So there is only a transplant.”

Ryan looked up from the envelope containing Teresa’s photograph, which he gripped with both hands, as if it were a buoy keeping him afloat. “Heart transplant?”

“We’ll register you with UNOS immediately.”

“UNOS?”

“The United Network for Organ Sharing. They ensure equitable allocation of organs.”

“Then…there’s a chance.”

“Frequently the results of a heart transplant are quite good. I have a patient who has lived the fullest life for fifteen years with a new heart, and she’s still going strong.”

Instead of ameliorating Ryan’s anguish, the possibility that he might escape death through a transplant rendered him even more emotional.

He did not want to be reduced to tears in front of Samar Gupta, and in searching for something to say that would help him stave off that embarrassment, he returned to the central theme of the past few days: “Could I have been poisoned?”

Dr. Gupta frowned. “Surely not.”

“Dr. Stafford did mention it as a possible cause of an enlarged heart. Though he also did…dismiss it.”

“But in studying the biopsied tissue,” the cardiologist said, “I feel quite sure your case is familial.”

“Familial?”

“Inherited. The cell characteristics are classic for a familial attribution.”

“You’re quite sure,” Ryan said, “but not certain?”

“Perhaps nothing in life is certain, Ryan.”

Having successfully repressed his tears, Ryan smiled thinly and said, “Except death and taxes.”

Dr. Gupta received Ryan’s smile with gratitude, and smiled himself. “Although at least the IRS will give you your day in court.”

In the days following his appointment with Dr. Gupta, Ryan surrendered to fits of denial during which he spent hours obsessively searching medical sites on the Internet for the latest developments in the treatment of cardiomyopathy.

When he found no scientific news dramatic enough to lift his spirits, he switched to alternative-medicine sites. Eagerly he sought stories about patients cured with the bark of an exotic Brazilian tree or with a tea brewed from the leaves of a plant found only deep in the jungles of Thailand.

Again and again, he read a thick packet of material about heart transplants, provided by Dr. Gupta. On each reading, his admiration for the skill of contemporary surgeons gave way to frustration over the imbalance between the number of patients in need of transplants and the number of organ donors, and to impatience with the system established by the health-care bureaucracy that was authorized to address that imbalance.

As he struggled to adjust to his radically altered future-or lack of one-Ryan avoided Samantha by pretending still to be in Denver on business.

Before seeing her, he wanted to live with his diagnosis long enough to begin to accept it. He intended to be in control of himself when he shared the news with her, because regardless of what happened between them, the meeting would be perhaps the most important of his life. He needed to be sufficiently composed to remain alert to every nuance of what she said, to every subtlety of her expressions and her body language.

The photo of Teresa continued to intrigue Ryan.

On the flight home from Colorado, he had brought the photo-analysis workstation that Wilson Mott established for him in the Denver hotel. It now stood on the desk in the retreat off the master bedroom.

When he could not ascertain if in fact a foreign object was lodged in the dead woman’s mouth, he next divided the photograph into eighty one-inch squares, enhanced them one by one, and analyzed them exhaustively. Some revelatory item might be snagged in her lustrous golden hair or half folded in a pillow crease. Or perhaps in a way impossible to fully imagine, a faint mark on her face might provide a clue that linked Teresa’s death to Ryan’s current crisis.

After he had studied twenty squares over two days, however, he began to feel that he was engaged in a foolish quest, that the photo had electrified him solely because Teresa was Samantha’s twin, which made seeing her in this condition seem like a clairvoyant glimpse of Sam’s death, therefore a profound shock.

Eventually he switched off the computer, intending to abandon his analysis of the portrait.