"Yet she had strong vitals, seemed no worse for wear from the first dose?"

"Her vitals were the same as before. And for your information, she'd fallen back to sleep. I remember thinking that the stronger dose hadn't worn off completely and maybe she didn't need the second shot just then, but went ahead with it anyway, given how she'd been screaming not half an hour earlier and you'd insisted we stay ahead of the pain." She'd resorted to pronouncing each word carefully and with perfect poise, as if speaking correctly could make what she'd done sound just fine.

Still, the plausibility of her explanation made him think that he'd probably gotten the truth from her. "And when did you next check her?"

Monica's face reddened to an even deeper shade of crimson.

"Let me guess," Earl said, feeling the pit of his stomach clench into a ball of muscle.

The taut defiance around her eyes slipped away, and, stealing a glance at the shrouded form, she seemed to age in front of him. "Six a.m.," she said, her voice reduced to a dry croak.

Jenny Fraser, chief of laboratories, had tracked Earl down in his office, where he'd retreated to think things over. "I have to warn you, Earl, Wyatt's riding my technician's ass for these results, but I heard what happened and wanted to get them to you first."

"That bad, are they?"

She gave a strained, tinny laugh. A small woman known for wearing pearls to a job that dealt with bodily fluids and slices of human anatomy, she also had a reputation for delivering bad news with the delicacy of a shark attack.

He braced himself.

"Unless the autopsy shows some catastrophic surprise, the cause of death will be morphine intoxication." Her slow cadence gave each word equal importance; it was a common technique used by clinical teachers in the belief it helped even the dimmest resident get the point. Except Jenny carried the practice over to talking with staff. "Her levels were double the normal therapeutic range."

"Shit."

"In your favor, her previous liver and renal tests showed normal function, so she should have theoretically been able to handle what you gave her, and no one could fault you for not thinking otherwise."

He knew all that, he thought as she continued to report her findings, had seen it in Elizabeth's chart before ever ordering the morphine. The truth was, Jenny couldn't provide the answers he needed now, such as how Elizabeth had survived the initial dose but not the second. How the first dose had worn off long enough to leave Elizabeth screaming with pain again, yet she'd managed to fall asleep before the second injection.

"Thanks, Jenny. I appreciate the heads-up," he said when she'd finished summarizing her take on the lab report.

After he put down the phone, a branching, cold logic took over his thinking, forking in various directions, and pointing to answers he didn't like.

He made a quick call to the operator, who connected him with the weekend nursing supervisor, Mrs. Louise Quint, as much a seasoned veteran at St. Paul's as himself. Like Earl, she harbored no illusions about the ruthlessness of hospital politics.

"Earl!" she said, her voice as hearty as ever. "I hear you're in the shithouse again. Just when I thought you finally got to the top of the crap pile. So much for my hopes the good guys might win a few for a change."

"Afraid so, Lou."

"What can I do to help?"

"I think Elizabeth Matthews may have gotten her dose of morphine twice."

"What!"

"You heard me."

"Why would you think that?"

"Because after midnight she woke up crying with pain again, the initial dose I ordered having worn off. Once she got like that, according to her husband, she couldn't rest. Yet around one she stopped crying, and Monica Yablonsky found her asleep when she finally went to check on her at one-thirty."

"So?"

"Apparently the staff had a busy night, especially during the time in question. I figure one of the other nurses might have given Matthews her injection after she first started to cry out, between midnight and one, but didn't sign it off in the order book or tell Yablonsky. Around one-thirty, when Yablonsky freed herself up from the other patients, she could have unwittingly given a second dose. Now they're both covering up."

"Jesus," she said, "that's pretty far-fetched." But Quint didn't dismiss the possibility outright. "Stay by the phone. I'm on it."

An hour later she called him back. "If one of my nurses gave an extra dose of morphine, they got it out of a private supply, because there's not a vial missing in the whole hospital." Her tone, now icy, made it clear that she considered the matter closed.

Every floor had a locked narcotics cupboard that required a pair of keys to open it, just like launching a nuclear missile, and the staff counted the vials at the start of every shift. Then they repeated the ritual on signing out, logging the ones they'd dispensed while on duty.

Not a foolproof system, but it uncovered mistakes, and to beat it took planning.

"They could have already replaced the vial they used?" he suggested, hoping she might not slam the door completely on his scenario. He'd need as many allies with open minds as he could muster to counter what Wyatt had in store for him.

"They'd have had to move awfully fast. And again, where would they acquire a substitute identical to the ones the hospital uses if not from the stores themselves? As far as I'm concerned, the whole notion's a nonstarter."

Unless they'd stolen it previously, he thought. Unfortunately, he hadn't a shred of evidence to be making such serious charges.

"Earl, I'd have gone to the wall for you if you had a case," Mrs. Quint added, her tone somber, "even against my own girls." Half her "girls" were pushing sixty, but she'd called them that from the days when they were rookies together, as if choosing not to notice they'd all aged, herself included. "But without proof, I fully expect you won't be repeating your allegations against them, even hypothetically."

Tough, blunt, and putting him on notice- he'd expected nothing less from her. "Thanks, Lou, for what you did."

He replaced the receiver in its cradle.

And felt very alone.

He'd no choice now but to await the outcome of an autopsy. As VP, medical, he could push to get the postmortem done quickly, but solving the mystery of Elizabeth Matthews's death at the cellular level took time. His authority couldn't hurry the process of preparing thin slices of her vital tissues on glass slides, marinating them for a required number of hours in a sequence of solutions to color their various structural features, then examining them under a microscope one by one. His fate would be in limbo for at least a week or two.

Then odds were that the official cause of death would simply echo what everyone already suspected, including him: morphine intoxication.

And Wyatt would move in for the kill.

Yet the politics of it hardly mattered, compared to what preoccupied him most about the whole affair.

If someone had overdosed Elizabeth Matthews, whoever did it had come prepared.

Sunday, July 6, 11:52 p.m. Palliative Care, St. Paul's Hospital

Sadie Locke had had a good day.

Thanks to that nice Dr. Garnet, she'd spent several hours enjoying the evening air sitting out on the roof of the west wing. It felt cool against her face, despite having to still wear her mask. He'd insisted on that, explaining that other patients would soon be allowed to make excursions there and they had to keep the area free of contamination, just like any other part of the hospital. The rest was great. A perimeter of potted trees rustling in the breeze reminded her of the parks where she'd watched Donny play near her home in Lackawanna, a former railway town south of Buffalo. Later, as the sun dropped lower over Lake Erie, birds gathered in the branches above her head, mistaking the pretend forest among all the concrete for the real thing. They'd darted happily from branch to branch, oblivious to the artificiality of it all, filling the air with evening song. Along the lake's edge in the distance, the brick chimneys of deserted factories that hadn't belched smoke since the days when she'd been a young mother now attracted black swirling clouds of starlings above their orifices. At some unseen signal, they reared by the thousands into the dusky sky, then swooped inside, as if those towering columns had sucked them back down to their last flittering dark speck.