"He cuts up girls and snuffs ICU patients?" said Milo. "Versatile."

Any trace of amiability left Fusco's face. "You have no idea," he said.

"You're talking nearly two decades of bad stuff and it's never come out? What, one of those covert federal things? Or are you out to write a book?"

"Look," said Fusco, jawbones flexing. Then he smiled, sat back. Let his eyes disappear in a mass of folds. "It's covert because I've got nothing to go overt. Air-sandwich time. I've only been on it for three years."

"You said two clusters. Where and when was the second?"

"Back here, in your Golden State. Fresno. A month after Huey Mitchell left Ann Arbor, two more girls were snagged off hiking trails, two weeks apart. Both were found tied to trees, cut up nearly identically to the Colorado and the Michigan vies. A hospital orderly named Hank Spreen left town five weeks after the second body turned up."

"Spreen," I said. "Shelly Spreen. He took his victim's name?"

Fusco grinned horribly. "Mr. Irony. Once again, he got away with it. Hank Spreen had worked at a private hospital in Bakersfield specializing in cosmetic work, cyst removals, that kind of thing. It was a big surprise when three post-op patients had sudden reversals and died in the middle of the night. Official cause: heart attacks, idiopathic reactions to anesthesia. That happens, but not usually three times in a row over a six-month period. The publicity helped close the hospital down, but by then Hank Spreen was long gone. The following summer, Michael Burke showed up at CUNY."

"Long body list for a twenty-two-year-old," I said. "A twenty-two-year-old smart enough to make it through pre-med and med school. He worked his way through by holding down a job as a lab assistant to a biology professor-basically a nighttime bottle washer, but he didn't need much income, lived in student housing. Had Grandma's dough. Pulled a 3.85 GPA-from what I can tell, he really earned those grades. Summers, he worked as an orderly at three public hospitals-New York Medical, Middle State General and Long Island General. He applied to ten med schools, got into four, chose the University of Washington in Seattle."

"Any coed murders during his pre-med period?" said Milo.

Fusco licked his lips. "No, I can't find any definite matches during that time. But there was no shortage of missing girls. All over the country, bodies that never showed up. I believe Rushton/Burke kept on killing but hid his handiwork better."

"You believe? This joker's a homicidal psychopath and he just changes his ways?"

"Not his ways," said Fusco. "His mode of expression. That's what sets him apart. He can let loose his impulses along with the bloodiest of them, but he also knows how to be careful. Exquisitely careful. Think about the patience it took to actually become a doctor. There's something else to consider. During his New York period, he may have diverted his attention from rape/murder to the parallel interest he'd developed in Michigan and continued in Bakersfield: putting hospital patients out of their misery. I know they seem like different patterns, but what they've got in common is a lust for power. Playing God. Once he learned all about hospital systems, playing ward games would've been a snap."

"How is he supposed to have killed all those patients?" said Milo.

"There are any number of ways that make detection nearly impossible. Pinching off the nose, smothering, fooling with med lines, injecting succinyl, insulin, potassium."

"Any funny stuff go down at the three hospitals where Burke spent his summers?"

"New York's the worst place to obtain information. Large institutions, lots of regulations. Let's just say I have learned of several questionable deaths that occurred on wards where Burke was assigned. Thirteen, to be exact."

Milo pointed down at the file folder. "All this is in here?"

Fusco shook his head. "I've limited my written material to data, no supposition. Police reports, autopsies, etcetera."

"Meaning some of your stuff was obtained illegally, so it can never be used in court." Fusco didn't reply.

"Pretty dedicated, Agent Fusco," said Milo. "Cowboy stuff's not exactly what I'm used to when dealing with Quantico."

Fusco flashed those big teeth of his. "Pleased to bust your stereotype, Detective Sturgis.

I didn't say that."

The agent leaned forward. "I can't stop you from being hostile and distrustful. But, really, what's the point of playing uptight-local-besieged-by-the-big-bad-Fed? How many times does someone offer you this level of information?"

"Exactly," said Milo. "When something seems to be too good to be true, it usually is."

"Fine," said Fusco. "If you don't want the file, give it back. Good luck chipping away at Dr. Mate. Who, by the way, began his own little death trip around the same time Michael Burke/Grant Rushton decided to seriously pursue a career in medicine. I believe Burke took note of Mate. I believe Mate's escapades and the resulting publicity played a role in Michael Burke's evolution as a ward killer. Though, of course, Michael had begun snuffing out patients earlier. Michael's main objective was killing people." To me: "Wouldn't you say that applied to Dr. Mate, as well?"

Calling Burke by his first name. The hateful intimacy born of futile investigation. Milo said, "You see Mate as a serial killer?"

Fusco's face went pleasantly bland. "You don't?"

"Some people consider Mate an angel of mercy."

"I'm sure Michael Burke could manipulate some people to say the same of him. But we all know what was really going on. Mate loved the ultimate power. So does Burke. You know all the jokes about doctors playing God. Here're a couple who put it into practice."

Milo rubbed the side of the table as if cleaning off his fingertips. "So Mate inspires Burke, and Burke goes up to Seattle for med school. He moves around a lot."

"He does nothing but move," said Fusco. "Funny thing, though: until he showed up in Seattle and purchased a used VW van, he'd never officially owned a car. Like I said, a retrovirus-keeps changing, can't be grabbed hold of."

"Who died in Seattle?"

"The University of Washington hasn't been forthcoming with its records. Au contraire, officially none of their wards have experienced a pattern of unusual patient deaths. But would you take that to the bank? There's certainly no shortage of serials up there."

"So now Burke's back to girls? What, he's the Green River Killer?"

Fusco smiled. "None of the Green River scenes match his previous work, but I know of at least four cases that do bear further study. Girls cut up and left tied to trees in semirural spots, all within a hundred miles of Seattle, all unsolved."

"Burke's fooling with I.V. lines by day, cutting up girls in his spare time, somehow working in med school."

"Bundy killed and worked while in law school. Burke's a lot smarter, though like most psychopaths he tends to slack off. That almost cost him his MD. He had to spend a summer making up poor basic-science grades, received low marks for his clinical skills, graduated near the bottom of his class. Still, he finished, got an internship at a V.A. clinic in Bellingham. Once again, I can't get hold of hospital records, but if someone finds an unusual number of old soldiers expiring under his watch, I'm not going to faint from shock. He finished an emergency medicine residency at the same place, got a six-figure job with Unitas, moved back to New York, and added another car to his auto arsenal."

"He held on to the van?" I said.

"Most definitely."

"What kind of car?" said Milo. I knew he was wondering: BMW?

"Three-year-old Lexus," said Fusco. "The way I see it, emergency medicine's perfect for a twisted loner-plenty of blood and suffering, you get to make life-and-death decisions, cut and stitch, the hours are flexible-work a twenty-four-hour shift, take days off. And important: no follow-up of patients, no long-term relationships, office or staff. Burke could've gone on for years, but he's still a psychopath, has that tendency to screw up. Finally did."