Jim unlocked the unit and guided me to Harry’s room, which was about the best we had at Episcopal-the medical equivalent of a penthouse suite. It had a wider bed than the cots on Twelve South and a couple of soft chairs in institutional brown next to a window that overlooked the East River. Harry was pacing up and down by them, clenching and unclenching a fist. He was wearing a crisp monogrammed shirt and looked livelier, but his expression wasn’t any more welcoming.

“Dr. Cowper has arrived, Mr. Shapiro. I’ll let you two have a talk,” Jim said, and he slipped back out. I heard the door to the ward click shut as he left.

“Hello, Mr. Shapiro. How are you feeling?” I said.

Harry glowered at me, his eyes burning.

“I want to leave,” he said quietly.

“I see. Well, let’s talk about that,” I said, crossing to his side of the room and taking one of the chairs.

He briefly stood there glaring before sitting opposite me. It was a lovely morning and the sun was casting a square of light on the floor. There were many worse places to get stranded-an airport, a police station-but his reaction was typical of people who woke up in a secure ward after being persuaded to sign in. They found themselves locked up, with sharp objects removed for safety, needing to ask permission for anything, and they went crazy if they weren’t in that condition already. I glanced at Harry’s notes. There was little there but a scrip for Klonopin, a longer-lasting tranquilizer than the Ativan I’d given out in the ER. His mental status had not been fully assessed, and he hadn’t been interviewed about his history or started on antidepressants. The only psych he’d talked to at length remained me, on Friday night.

“How have you been sleeping?” I said.

“I want to leave,” he repeated slowly, as if I hadn’t listened the first time. I found it hard to hold his intense gaze.

I tried to prevaricate. “I know it must be difficult to be here, but I think it’s a good idea to talk so I can get a sense of how you are. Then we can start on treatment and you can leave, maybe in a day or two. We don’t want to keep you in here any longer than you’re comfortable with, believe me.”

Harry flinched with irritation and got up to stare out of the window. “I don’t think you heard what I said,” he growled over his shoulder.

I didn’t like what I was seeing. Harry was just as moody as he’d been in the ER, but more agitated, which was a bad combination. Patients who are very depressed may think of killing themselves, but they lack the energy to do it. The trickiest moment is when they start to feel slightly better and more capable of action. He was also angry, which was worrying. Suicide is an act of hostility, not only to the suicide victim himself, but also to the person he blames for his plight.

All in all, I wasn’t inclined to release Harry before he had stabilized and I had a better sense of what was going on in his head. Legally, I was in a far stronger position than he. Having signed himself in, he could petition to be let out at any time. But the hospital was allowed to hold him for seventy-two hours before his lawyers could spring him. It would be a disaster if things got that far, given that Harry had paid for the wing in which he was incarcerated, but I didn’t imagine that it would. Three days would be plenty as long as he calmed down.

“What worries you about being here?”

“I can’t sleep,” he said, turning to me. “The bed’s uncomfortable, the blankets are thin, I was cold all night. The traffic noise kept me awake. I’m fine, don’t you understand? There’s nothing wrong with me.”

I listened to the buzz of the cars on the FDR Drive. It sounded pretty routine for New York, and fainter than the noise in my own apartment, but that wasn’t the point. Anxiety and wealth had made Harry hypersensitive. The thread count on the grayish sheets was lower than he was used to, and there was no goose-down duvet. He wouldn’t have noticed either if he’d been at ease.

“I’m sorry, Mr. Shapiro. Perhaps we can discuss all this with your wife and make a discharge plan. We’ll try to agree on a way forward.”

Harry gave a cynical grunt, but he at least agreed to wait for Nora. On the way back to Twelve South, I considered my predicament. Jim’s escape to Westchester had put me in charge of Harry, and he was becoming a difficult assignment despite my earlier wish to get hold of him. I couldn’t in good conscience let him out immediately, but he had a lot more power than most patients-and no compunction about using it.

My best hope, I thought, was Nora.

An hour later I was standing in what we generously called the library, a room with a sprinkling of books and a computer on which patients could send email, listening to Lydia Petrovsky, a birdlike patient who had been with us for a week. Unlike Harry, she showed no sign of wanting to leave-quite the opposite-but her insurer was threatening to withdraw coverage and the finance department wanted her out. As I was trying to persuade her to go back to her apartment and attend the day clinic, my pager vibrated with a summons to see the president.

Sarah Duncan’s office was in a corner of the Shapiro Pavilion, with a view toward the Queensboro Bridge that went to waste. Her twin assistants were both pale and pretty, in their mid-twenties, and dressed immaculately in short skirts and chunky jewelry. One gave me a bottle of water from a small refrigerator and a pro forma apology for Duncan keeping me waiting, which seemed to be the normal course of events. Then she returned to clicking through emails. Since no one else was appreciating the view, I looked at the cars rumbling over the bridge from Queens to Manhattan. The Williamsburg Bridge and the far reaches of Brooklyn were visible through its girders as a cable car looped its way to Roosevelt Island.

“Dr. Cowper?” said a low voice from the doorway, making me jump in surprise. “Please come through.”

Duncan had translucent eyes, silver hair shorn into a bob, and a face that was too smooth to be natural. She scared me. I followed her into a cool corner office that was laid out neatly with no stray papers. There was a sofa, two armchairs, and a glass-topped desk with two inch-thick files resting on it, a fountain pen set precisely beside them. None of the furniture was the standard-issue stuff of the kind that cluttered the rest of the place. She stood by her desk, moving a sheet of paper in front of her and examining it minutely.

“Dr. Cowper, I’ve just been reading about your work here.” She tapped the file. “Very impressive, I must say. You are clearly a highly valued member of the team,” she said, as if pinning a minor medal on me.

“Thank you, Mrs. Duncan. That’s kind.”

“I didn’t interrupt you, by the way? You have a few minutes to spare?”

“It sounded as if it was urgent.”

“That’s one thing I like about doctors-always ready for an emergency,” she said with a curt laugh as she gestured for me to sit opposite her on a sofa. There were clearly other things about us that she didn’t like. “This must be one of the trickiest situations I’ve faced in my time here.”

“I take it you mean Mr. Shapiro?”

“I count myself as a friend of Nora Shapiro, whom I recruited to our board, so I’m anxious to do everything we can for them. You did the right thing to admit him, but I’m hearing that he now prefers to be discharged.”

“He told me so this morning.”

“I take it that we can fulfill his wishes,” she said, gazing at me firmly.

There was a pause while I thought about what to say, apart from: Mind your own business. You’re a bureaucrat, not a doctor. I’d taken the Hippocratic oath to heal patients, while she was in charge of keeping the books balanced. We’d always been assured that when the two clashed, Hippocrates won.

“That might not be best immediately. I’m worried about him leaving while in a fragile condition. I’m sure you understand.”