“The diagnosis in unequivocal,” said Dr. Wiley softly.

“What kind of leukemia?” asked Charles, running his hand through his hair and looking out the window at the neighboring brick wall. “Lymphocytic?”

“No,” said Dr. Wiley. “I’m sorry to say but it’s acute myeloblastic.”

I’m sorry to say… I’m sorry to say… a stock medical phrase that doctors resorted to when they didn’t know what else to do and it echoed unpleasantly in Charles’s head. I’m sorry to say your wife died… It was like a knife plunging into the heart.

“Circulating leukemic cells?” asked Charles, forcing intelligence to struggle against memory.

“I’m sorry to say, but there are,” said Dr. Wiley. “Her white count is over fifty thousand.”

A deathly silence descended over the room.

Abruptly Charles began to pace. He moved with quick steps, while his hands worked at each other as if they were enemies.

“A diagnosis of leukemia isn’t certain until a bone marrow is done,” he said abruptly.

“It’s been done,” said Dr. Wiley.

“It couldn’t have,” snapped Charles. “I didn’t give permission.”

“I did,” said Cathryn, her voice hesitant, fearful she’d done something wrong.

Ignoring Cathryn, Charles continued to glower at Dr. Wiley.

“I want to see the smears myself.”

“I’ve already had the slides reviewed by a hematologist,” said Dr. Wiley.

“I don’t care,” said Charles angrily. “I want to see them.”

“As you wish,” said Dr. Wiley. He remembered Charles as a rash but thorough student. Apparently he hadn’t changed. Although Dr. Wiley knew that it was important for Charles to substantiate the diagnosis, at that moment he would have preferred to talk about Michelle’s extended care.

“Follow me,” he said finally and led Charles out of the conference room and down the hall. Once the conference room door opened a cacophony of crying babies could be heard. Cathryn, initially unsure of what to do, hurried after the men.

At the opposite end of the corridor they entered a narrow room which served as a small clinical lab. There was just enough space for a counter and a row of high stools. Racks of urine samples gave the room a slightly fishy aroma. A pimply faced girl in a soiled white coat deferentially slid off the nearest stool. She’d been busy doing the routine urinalysis.

“Over here, Charles,” said Dr. Wiley, motioning to a shrouded microscope. He plucked off the plastic cover. It was a binocular Zeiss. Charles sat down, adjusted the eyepieces, and snapped on the light. Dr. Wiley opened up a nearby drawer and pulled out a cardboard slide holder. Gently he lifted one of the slides out, being careful to touch only the edges. As he extended it toward Charles, their eyes met. To Dr. Wiley, Charles looked like a cornered animal.

Using his left hand, Charles took the slide between his thumb and first finger. In the center of the slide was a cover glass over what appeared to be an innocuous smudge. On the ground glass portion of the slide was written:

Charles’s hand trembled as he placed the slide on the mechanical stage and put a drop of oil on the cover glass. Watching from the side he lowered the oil immersion lens until it just touched the slide and entered the oil.

Taking a deep breath, Charles put his eyes to the oculars and tensely began to raise the barrel of the scope. All at once a multitude of pale blue cells leaped out of the blur, choking off his breath, and forcing the blood to pound in his temples. A shiver of fear as real as if he were looking at his own death warrant blew through his soul. Instead of the usual population of cells in all stages of maturation, Michelle’s marrow had been all but replaced by large, undifferentiated cells with correspondingly large irregular nuclei, containing multiple nucleoli. He was gripped by a sense of utter panic.

“I think you’ll agree it’s rather conclusive,” said Dr. Wiley gently.

With a crash, Charles leaped to his feet, knocking his stool over backwards. An uncontrollable anger, anger pent up from the exasperating morning and now fired by Michelle’s illness, blinded him. “Why?” he screamed at Dr. Wiley, as if the pediatrician were part of an encircling conspiracy. He grabbed a fistful of the man’s shirt and shook him violently.

Cathryn leaped between the two men, throwing her arms around her husband. “Charles, stop!” she shouted, terrified of alienating the one person she knew they needed to help them. “It’s not Dr. Wiley’s fault. If anyone’s to blame, it’s us.”

As if waking from a dream, Charles embarrassingly let go of Dr. Wiley’s shirt, leaving the surprised pediatrician’s bow tie at an acute angle. He bent down and righted the stool, then stood back up, covering his face with his hands.

“Blame is not the issue,” said Dr. Wiley, fumbling nervously with his tie. “Caring for the child is the issue.”

“Where is Michelle?” asked Charles. Cathryn did not let go of his arm.

“She’s already been admitted to the hospital,” said Dr. Wiley. “She’s on Anderson 6, a floor with a wonderful group of nurses.”

“I want to see her,” said Charles, his voice weak.

“I’m sure you do,” said Dr. Wiley. “But I think we have to discuss her care first. Listen, Charles.” Dr. Wiley reached out a comforting hand, but thought better of it. Charles’s fury had unnerved him. Instead he put his hands in his pockets. “We have here at Pediatric one of the world’s authorities on childhood leukemia, Dr. Stephen Keitzman, and with Cathryn’s permission I’ve already contacted him. Michelle is a very sick little girl, and the sooner a pediatric oncologist is on the case the better. He agreed to meet with us as soon as you arrived. I think we should talk to him, then see Michelle.”

At first Cathryn wasn’t sure about Dr. Stephen Keitzman. Outwardly he was the opposite of Dr. Wiley. He was a small, young-looking man with a large head and thick dark, curly hair. He wore rimless glasses on a skinny nose whose pores were boldly evident. His manner was abrupt, his gestures nervous, and he had a peculiar tic that he displayed during pauses in his speech. All at once he’d curl his upper lip in a sneer that momentarily bared his capped teeth and flared his nostrils. It lasted only an instant but it had a disquieting effect on people who were meeting him for the first time. But he was sure of himself and spoke with an authority that made Cathryn feel confidence in the man.

Certain that she would forget what was being told to them, she pulled out a small notebook and ballpoint pen. It confused her that Charles didn’t seem to be listening. Instead he was staring out the window, seemingly watching the traffic inching along Longwood Avenue. The northeast wind had brought arctic air into Boston and the mixture of light rain and snow had turned to a heavy snow. Cathryn was relieved that Charles was there to take control because she felt incapable. Yet he was acting strangely: angry one minute, detached the next.

“In other words,” summed up Dr. Keitzman, “the diagnosis of acute myeloblastic leukemia is established beyond any doubt.”

Swinging his head around, Charles surveyed the room. He knew that he had a precarious hold on his emotions, and it made it difficult to concentrate on what Keitzman had to say. Angrily he felt he’d spent the whole morning watching people undermine his security, dislocate his life, destroy his family, rob him of his newly found happiness. Rationally he knew there was a big difference between Morrison and Ibanez on the one hand and Wiley and Keitzman on the other, but at the moment they all triggered the same unreasoning fury. Charles had great difficulty believing that Michelle had leukemia, particularly the worst possible type, the most deadly kind. He had already been through that kind of disaster; it was someone else’s turn.