She sighed and tapped her finger on the arm of the sofa. “Dr. Cowper, you’re a young man and you’ve got a long and hopefully distinguished career ahead, so let me explain something to you, between ourselves. The Shapiros are very important to the future of this hospital. I recently discussed with Nora our plans for a new cancer wing, and she’s talked of making a generous donation that might help to save thousands of lives.”

“I see,” I said, shifting in my seat.

I remembered not taking Duncan’s call in the ER, gesturing to Maisie that I wasn’t available. How smart I’d been then and how stupid now to be in the middle of this political mess. How could I balance my duty to help Harry against the lives of others whom his money might help? The trouble with psychiatry was that patients believed they could diagnose their own state of mind pretty well, and the more disturbed they were, the more likely to believe they were fine. It was Harry’s view of himself against mine.

“If we lost her support, that would be a tragedy, not just for us but for many, many patients.”

“I see that, but-”

“So, look. The last thing I want is to interfere in your treatment of Mr. Shapiro, but surely he can be cared for outside these walls?”

“Well …” I paused, trying to think of a way out. “I’ve agreed with Mr. Shapiro that we’ll talk with his wife later and agree on a plan.”

Duncan gave me a frosty smile as she got to her feet. “Good. I’ll leave you to make a decision.” She walked to her desk and, as I got halfway out the door, added in a low voice: “Do ensure it’s the right one.”

I found Harry sitting with Nora in the patients’ lounge in York East, which looked like a hotel lobby. It had halfway decent furnishings and a flat-panel television-an advance on the old cathode-ray sets fixed to the ceiling in Twelve South. There was no one else in the room, just the two of them side by side on a sofa with hands intertwined.

Nora disentangled hers and got to her feet, leaving Harry sitting by himself. “I’m so glad to see you again, Dr. Cowper,” she said.

Seeing her, I had the same feeling as the first time. She wasn’t like Harry or Duncan, with their easy recourse to intimidation. She didn’t behave like a powerful person or someone on a higher social level-her affect was of surprise at being in that position at all. After my encounter with Duncan, I knew the only way I could avoid either doing something I felt unhappy about or making myself unpopular with my employer was to persuade Nora that her husband should stay for a few days. That would require me to be blunt.

“Perhaps you and I should have a chat in private. Would you mind if we used your room for ten minutes, Mr. Shapiro?”

Harry nodded guardedly, as if he were suspicious of my intentions but couldn’t think of a reason to refuse. I closed Harry’s bedroom door behind us and turned to find Nora already sitting on the bed with her legs crossed and one heel on the ground. It felt too intimate to sit next to her on the bed; I thought of staying on my feet, but that didn’t seem right either. I needed to woo her a little to persuade her to keep Harry with us, so I compromised by sitting at the other end of the bed, by the pillows.

“Your husband told me he wants to discharge himself immediately, Mrs. Shapiro. How do you feel about that?” I started cautiously.

“I don’t know what’s best for him, Doctor. He’s very upset, and I think he blames me for forcing him to come here. I only wanted to help.”

She looked fragile, and I saw tiny lines form by her eyes as she frowned. I liked the way that she hadn’t succumbed to the Upper East Side surgeons the way Duncan seemed to have done. It took nerve for someone in her circle to resist the peer pressure to have a blandly perfect face.

“You did the right thing, but I’m worried about your husband’s mood at the moment. I’m sure he’ll recover, but I’d feel happier if you could persuade him to stay a few days, just to get his treatment under way.”

“Are you worried he’d …?”

Her voice trailed away and I looked firmly into her soft eyes, not wanting to miss my best opportunity.

“To be frank, I am still concerned about self-harm. I’m sure he’d listen to you if you advised him not to leave.”

Nora looked down hesitantly. “I don’t know if I can do that. He’s very unhappy, and he’s not listening to me anymore. Can’t he be treated as an outpatient? I’ll make sure he’s safe. I’ve locked that gun away, like you told me.”

I pursed my lips as I thought. I didn’t feel happy about letting Harry leave in that state, but if Nora couldn’t help, then I’d have to defy both Harry and Duncan to keep him there. It was the slim chance of Harry killing himself against my certain career suicide if I stood in his way. Nora looked at me pleadingly and I felt myself weaken. She’d shown that she would look after her husband, I reflected. It wasn’t as if I would be discharging someone who had no one to guard him.

“Well, if you believe that you can’t change his mind … But we need to have a plan in place, and he would have to enter treatment immediately for his own sake. Do you know a psychiatrist he’d agree to see regularly?”

“Harry wants you to be his doctor,” she said. “He likes you.”

That gratified me, I have to admit. Harry did want me to treat him, as I’d hoped. Jim wouldn’t be happy, but I didn’t care. It was also a relief, which is how I justified it to myself. If I had to discharge Harry, I’d at least be able to watch over him. Anyway, there was no alternative: he had both Nora and Duncan on the run. I put him on Lexapro, an antidepressant that wouldn’t make him more agitated, and half a milligram of Klonopin twice a day. I arranged to see him in two days at my office and gave her my number to call if his mood worsened.

Then, signing my name on the release, I let him go.

On Tuesday the phone rang just after dawn, jolting me from sleep into the gray bedroom light. I fumbled for the receiver, which still sat on Rebecca’s side.

“Ben?” said a high voice that I recognized as my father’s second wife. “Were you asleep? Or is it evening?” Jane had a shaky grasp of time zones and often added the five-hour difference between London and New York instead of subtracting.

“No, it’s fine. I’m up,” I said, lying instinctively and squinting at my alarm clock. “It’s six. Six in the morning.”

“It’s your father,” she said, ignoring the implausibility of the denial. “He’s had a heart attack, but he’s okay, I think. He’s in West Middlesex Hospital.…”

She trailed off uncertainly, as if unsure of where she was or what to do, and I felt a pang of sympathy for her, which was unusual. My doziness had evaporated, and I struggled to grasp what had occurred while my emotions jostled uncertainly in the background. I wanted him to be okay, but there was something murkier, too-a guilty satisfaction that he was mortal. Even he could be knocked off his triumphalist course.

“He was fine when he woke up. He was in the kitchen making himself coffee, talking to me about a case. Then he said he was getting a pain in his arm. He tried to sit down, but he fainted. I called the ambulance.”

“Is he conscious now?”

“Yes, he came round in the hospital. They’re doing tests. Is Rebecca there? I thought she would know what to do.”

My girlfriend-or former girlfriend, as I was coming to accept-had removed her stuff a couple of weekends before, taking her bewilderment and hurt out on the apartment wall. In the living room, I’d found her desk and shelves gone, leaving a dozen holes in the wall for the resident-in this case me-to stitch up. I’d peered at the wounded plaster in places where she’d clearly lost her composure and ripped out screws, and I’d thought how unusual it was. She was noted for her calm precision as a surgeon.