The remaining faces were those of strangers. He returned to the nurse. Not Ismay, surely. Ismay’s other.

If these events had a theme, it was identical twins. Samantha and Teresa. Lily and her deranged sister with the switchblade.

Ryan heard a rapping, but it was Zane or Sienna in another room, sounding out a wall for indications of a hidden cache.

He had no idea in what town Ismay Clemm lived. Because her name was unusual, Ryan used his cell to avail himself of a new information service that searched for listings not by city but by area code. He could find no number for Ismay in either the 949 or 714 areas, which might only mean that her phone was unlisted.

At four o’clock on a Sunday afternoon, reaching Dr. Gupta to ask after Nurse Clemm would be difficult. Getting to him on a week-day would be no easier.

A year ago, after discovering that his patient had been under the care of Dr. Dougal Hobb for more than a month, Dr. Gupta had sent Ryan’s records to Hobb, and a curt note to Ryan expressing dismay that he had not been informed sooner of this decision. He was not likely to take or return a call.

As a consequence of all this, Ryan had changed internists, as well. He moved from Forry Stafford to Dr. Larry Kleinman, who offered a concierge medical practice.

He considered calling Kleinman’s 24/7 contact number to ask if the doctor would be willing to seek from the hospital the name of the other cardiology nurse who had assisted Gupta in the biopsy that day. But as he stared at the death portrait of Ismay’s twin, he remembered the lean nurse whose body fat was less than a cricket’s. Whippit. No. Whipset. First name Kara or Karla.

Of the Whipsets that he found in the 949 area code, one had a first name similar to what he recalled. He recognized it at once: Kyra.

He placed the call, and she answered on the third ring.

After he identified himself and apologized for intruding on her privacy and on her Sunday, Ryan said, “I’m hoping you might know how I can get in touch with Ismay Clemm.”

“I’m sorry. Who?”

“The other nurse who assisted in the procedure that day.”

“Other nurse?” Kyra Whipset said.

“Ismay Clemm. I very much need to talk to her.”

“I don’t know anyone by that name.”

“But she assisted during the biopsy.”

“I was the only nurse on the procedure, Mr. Perry.”

“A black woman. Very pleasant face. Unusual dark-green eyes.”

“I don’t know anyone like that.”

“Could she have been…assisting unofficially?”

“I think I would remember. Anyway, it’s not done.”

“But she was there,” he insisted.

His conviction made Nurse Whipset uncertain. “But how did she assist, what did she do?”

“When the first tissue sample was taken, she told me not to hold my breath.”

“That’s it? That’s the extent of it?”

“No. She also…she monitored my pulse.”

“How do you mean?”

“Well, she stood beside the examination table, holding my wrist, checking on my pulse.”

With a note of bewilderment, Kyra Whipset said, “But throughout the procedure, you were hooked up to an electrocardiograph.”

He tried to recall. The memory wouldn’t clarify.

Nurse Whipset said, “An electrocardiograph with a video display. A machine monitored your heart activity, Mr. Perry.”

Ryan remembered the fluoroscope on which he had watched the tedious progress of the catheter as it followed his jugular vein into his heart.

He could not recall an electrocardiograph. He could not say for certain that she was wrong, and he had no reason to suspect that she might lie to him. But what he remembered instead of the ECG was Ismay Clemm.

“After the procedure, I had to lie down on the bed in the prep room, to let the sedative wear off. She checked in on me a few times. She was very kind.”

“I looked in on you a few times, Mr. Perry. You were dozing.”

Staring at the death portrait in the ring binder, he said, “But I remember her clearly. Ismay Clemm. I can see her face now.”

“Can you spell the name for me?” Nurse Whipset asked.

After he spelled it, she spelled it back to him to make sure she had gotten it right.

“Listen,” she said, “I suppose it’s possible for some reason she briefly visited the diagnostics lab during the procedure, and I was too busy to pay much attention to her, but she made an impression on you.”

“She made an impression,” he assured Kyra Whipset.

“Because of the sedative, you might not recall it clearly. Your memory might have exaggerated her time in the room, the level of her involvement.”

He did not disagree with her, but he knew it had not been that way, not that way at all.

“So,” she said, “give me a number where I can reach you. I’ll make a couple of calls to people at the hospital, see who knows this woman. Maybe I can get contact information for you.”

“I’d appreciate that. Very kind of you,” he said, and gave her his cell number.

Rap-rap-rapping: George Zane and Cathy Sienna testing walls, testing cabinets.

Ryan removed Ismay Clemm’s death portrait from the plastic sleeve in the ring binder and put it on the desk.

The sharpening wind was a scalpel now, stripping the skin off every tract of bare land it found. Beyond the window, trees shuddered in clouds of yellow dust, in the acid-yellow light of late afternoon.

From the manila envelope that he had brought with him, Ryan took the photos of Teresa Reach and Lily X. He lined them up with the death portrait of the woman who looked like Ismay Clemm.

He knew now a disquiet that was different in character from any he had known before.

This journey had taken him from dead-center in the realm of reason, where he had lived his entire life, to the outer precincts, where the air was thinner and the light less revealing. He stood on the borderline between everything he had been and a new way of being that he dared not contemplate.

He had half a mind to return two photos to the ring binders and leave at once with just the picture of Lily.

The problem with that was-he had nowhere to go except home, where sooner or later he would be slit open and have his heart cut out of him again, this time without anesthetics.

After a while, the air acquired a faint alkaline taste from the dust-choked wind that relentlessly groaned and snuffled at the windows.

When eventually Ryan’s cell phone rang, the caller was not Kyra Whipset, but a woman named Wanda June Siedel, who said that she was calling on Nurse Whipset’s behalf.

“She says you want to know about Ismay Clemm.”

“Yes,” Ryan said. “She was…very kind to me at a difficult time in my life.”

“That sounds like Ismay, all right. Sure does. She and me were eight years best friends, and I don’t expect ever to know somebody sweeter.”

“Ms. Siedel, I’d very much like to talk with Nurse Clemm.”

“You call me Wanda June, son. I would sure like to talk to Ismay myself, but I’m sorry to tell you, she’s passed on.”

Gazing at the nurse’s photo on the desk, Ryan avoided for the moment his most important question. Instead he said, “What happened?”

“To be blunt, she married wrong. Her first husband, Reggie, he was a saint to hear Ismay tell it, and I expect he must have been if half her stories about him were true. But Reggie, he died when Ismay was forty. She married again seven years later, that was to Alvin, which is why she came here and I ever met her. She loved Alvin in spite of himself, but he never set well with me. They made it eight and a half years, then she fell backwards off a convenient stepladder and smashed the back of her skull bad on some convenient concrete.”

When Wanda June did not continue, Ryan said, “Convenient, huh?”

“Son, don’t take me wrong on this. I’m making no accusations, have no intention to smirch anyone’s reputation. Lord knows, I’m no policeman, never even watched them CSI shows, and there was plenty of policemen on Ismay’s case, so it’s got to be that they knew what they were doing when they called it an accident. Can’t be but crazed with grief and loneliness why Alvin took up with another woman just a month after Ismay’s gone. Crazed with grief and loneliness, crazed by the estate money and the insurance money, poor crazed and lonely Alvin.”