He sat back. "I'll take some facial measurements, then computer-image projections. You'll have several options. Now, you wanted to consider a breast augmentation?"

She lowered her eyes and nodded. "When I had the children – you know."

"Of course," he said soothingly. "Let's have a look."

She reached behind to untie the gown, then lowered it shyly, her eyes still downcast, like a woman unveiling herself for a first-time lover.

D'Anton studied the pendulous breasts for a moment, quickly deciding on implant type and size. He lifted the nearer one, gauging the condition of the tissue, and felt her shiver slightly. Her lips were parted; her breath quickened, her eyes half closed. He almost smiled. It was a moment he always savored.

"Very good, Lucia," he said, clasping her hands in both of his. "I'm betting we can make your daughter jealous. Why don't you go ahead and get dressed, and I'll have my staff set you up a schedule."

D'Anton stepped out into the hall. Then his body jerked slightly, at the abrupt realization that one of his nurses, Phyllis Quires, was waiting for him. She was a squarely built, stolid woman, but she moved with amazing stealth; often he would turn around and find her simply there. He demanded deference, but sometimes she set his teeth on edge.

"Yes?" he said, in the clipped, brusque tone he used with employees.

Phyllis did not usually show emotion, but now her face looked pale.

"Doctor, Mercy Hospital just called," she said. "A woman who had breast surgery yesterday, Eden Hale? She died early this morning in their Emergency Room."

D'Anton's mouth opened as comprehension took hold. His right knee buckled a few inches suddenly, as if he had taken a hard punch to the jaw. His hand fluttered from his side, groping for a wall to brace himself against.

Phyllis stepped to him quickly and took his other arm.

"I'm so sorry, Doctor," she said. "It's not fair that something like this should come along and bother you."

You know this as soon as you wake, hours before dawn: that tonight you will find the one who calls you. Stride through the city like a lion, your coat radiant, your teeth swords, your lungs filling with the scent of her sweet perfume, and blood.

In the closet where you keep your secret things are souvenirs from earlier times, pieces of jewelry that glow in the darkness with the light of the women who wore them. You can feel it in your fingers as you rub them – a little trace left over from that warmth they gave to you. Each piece has a voice, replaying her last words and sounds, music to accompany the film in your head. You like to listen to them one at a time, but sometimes you hold them all together and close your eyes and crouch there in the dark, until they blend into one murmuring song, like wavelets into surf.

You knew long ago, when you first began, that all women want beauty – but it comes at a cost. Changing their flesh is a start. But getting to the real, deep perfection they secretly crave is something only you can do.

The first hint of daylight starts to enter the room.

It's important to make this day look like any other, so you get ready for work. But first, you check to make sure of the other things you're going to need. Scrubs and gown. Latex gloves. Plastic bedding. Plenty of towels.

A sterile surgical tray, with a selection of scalpels.

Immediately after his shift ended at seven a.m., Monks walked downstairs to the hospital's basement and through the long corridor to the morgue. This was a different world than the floors above, which had their elements of grimness, to be sure – they were filled with sickness and pain – but were devoted to healing.

This world below belonged to the dead: here, hope had been abandoned. The hall was deserted and sepulchral, like a subway tunnel, with none of the bustle of upstairs. Footsteps gave off faintly sinister echoes. The faded paint on the walls and the chipped floor tiles, intended to be complementary shades of off-white, had merged over the years into a monotone the color of yellowed teeth that no amount of cleansing or repainting could freshen for long.

But research on the dead provided much of the knowledge that healed the living.

Monks pushed open one of the morgue's double doors, gray steel except for small squares of glass at eye level, and stepped inside. The room was barren concrete, with drains in the floor and, along one wall, what looked like a row of giant filing cabinets. Eden Hale was inside one of them.

The pathologist's glassed-in office occupied one corner. Other furnishings included several racks of surgical equipment, sinks, and two stainless-steel tables. On one of these, a pair of bare feet, toes up, faced Monks. A slender man wearing wire-rimmed glasses and surgical barrier gear was bent over the body. He was wielding the implement known as the bread knife, a sixteen-inch blade sharp as any samurai sword, which could literally cut a cadaver in half. This was Dr. Roman Kasmarek, Mercy Hospital's chief pathologist. Roman was usually in the lab before six a.m., examining tissue samples from the day's first surgeries, then starting autopsies as time allowed.

Monks did a quick inventory. The procedure was nearing its end. A scale was weighted with a hanging organ, and a brain was trussed with string and suspended inside a jar of formalin until it was "fixed" – the soft tissue hardened, to keep it from being damaged by handling. There was a slick of blood and fluids around. Roman was neater than most pathologists Monks had known, but it was still messy business.

His longtime assistant, an ageless gray-haired black man, was rinsing the intestines in a sink, preparatory to opening them. His name was Clifford, but he was known in the hospital as Igor, a reference to his hunched shuffle. He was crafty and wise, and for some reason seemed to like Monks. He flashed a sidelong grin that suggested some illicit secret between the two of them.

Roman, absorbed in his dissection, had not yet looked up. Igor moved to tap him on the shoulder but prudently waited until Roman set down the bread knife before getting that close. Monks recalled a legendary nineteenth-century British surgeon who had made his reputation via lightning-quick amputations, with the limb typically hitting the floor in as little as ninety seconds. Since these were performed without anesthesia, the shortening of the patients' agony was a blessing. The downside was, they usually died of sepsis or shock, and the doctor's scalpel tactics were so aggressive that he was prone to severing testicles along with legs. On one stellar occasion, his flashing blade gutted his assistant, and an observer was so horrified that he keeled over with a heart attack. When the patient succumbed, shortly afterward, the mortality rate reached a whopping 300 percent.

Back at the sink, Igor was wielding his own knife. The first smell of sliced intestines, an experience never to be forgotten, reached Monks's nostrils. He stepped into the hall. Roman joined him a minute later. Dabs of Vicks glistened under his nose. It was probably not easy to look sympathetic while dissecting a cadaver, but he managed.

"Is this about the young woman who died?" Roman said.

Monks nodded.

"I'm sorry, Carroll. I know it's tough on you to lose somebody."

"Somebody young and healthy. What happened doesn't make any sense."

"I only know that she was brought in. Not the details."

"She had DIC, Roman."

Roman's eyebrows rose. "Really." DIC was unusual in itself; the designation "young and healthy" made it extremely so.

"I'm sure of it. But I don't have a clue what caused it. Goddammit, the circulatory system of a vital twenty-five-year-old does not just shut down."