"… me, I'm following my nose to the coffee…"

Surgical masks couldn't hide that they seemed younger than ever, he thought, indulging in a twinge of melancholy. He'd been through twenty-five changeovers and found the day marked the passing of yet another year with more impact than his own birthday.

He continued at a brisk pace toward the emergency department and pressed a large metal disc on the wall, setting off a loud hiss as the frosted glass barrier that separated his domain from the rest of the hospital slid open.

Just like Captain Kirk on the Enterprise, he thought, stepping through with a grin, only to have the volume of chatter coming from inside wipe it away.

That much sound meant a lot of patients. Too many.

"Morning, Dr. G.," the triage nurse greeted him. She was a cheery woman in her mid-twenties. He knew her mask hid three rings in her right nostril, and slightly spiked but short black hair stuck out from beneath her surgical cap. She glanced up from taking the blood pressure of an elderly lady who had frizzy white hair and lay gasping for breath on an ambulance stretcher, a red handbag clutched to her chest with both hands. She also was masked, and her frightened eyes stared at him over its tight-fitting rim. The material puffed in and out with each respiration.

To the left the walking wounded, equally well masked, kept their distance, prowling a waiting room meant to hold half their number. On the right another sliding door led to the inner sanctums of ER, where patients unable to sit or stand would be parked on stretchers.

"Morning, J.S.," he replied, raising his voice to make himself heard above the chatter of a hundred conversations.

The initials stood for Jane Simmons. They'd used call letters to address each other since shortly after she came on staff. It began, as did many traditions between people in ER, during the rush of a resuscitation. The intensity often cemented first impressions- for better or worse- and her impact on him had stuck for the better. Despite dressing the part of a punk rocker, she had good hands when it came to starting IVs in the worst of veins, and her calm never cracked- not then as a new kid, and not since, even during the toughest cases.

"Need any help?" he asked her. The elderly woman's rapid breathing had automatically put him on alert.

" Nan." J.S. reassuringly patted the lady's arm. "Meet Mary."

"Hi, Mary, I'm Dr. Garnet, the guy who runs the joint." He placed his gloved hand over hers and gave it a gentle squeeze.

"Only a touch of heart failure," J.S. continued, "but this little sweetie's going to be just fine as soon as we give her oxygen, relax her airways, and get her peeing."

Some of the fear drained from the old woman's gaze, and she appeared less forlorn despite the puffy circles drooping over the upper edge of her mask. An orderly whisked her through the inner door and down the hallway to a treatment room.

"Ready to whip another crop of greenhorns into shape?" Earl asked J.S. while glancing over the ambulance sheet to see what calamities the city of Buffalo had delivered up overnight. He mentally ticked off the cases that he could use as good teaching material for introducing first-year residents to ER.

The corners of her eyes crinkled, and he knew her infectious, crooked grin had appeared. She lifted an upper tie to loosen the corner of her mask and blew a strand of loose hair off her forehead. "Just let me at 'em."

Before he could remind her that she shouldn't breathe unfiltered air, even for a second, a single low growl from a siren announced the arrival of another ambulance. The signal meant they'd brought in a patient still breathing, but barely, who needed help fast.

J.S. pivoted and charged out the door leading to the garage.

Several nurses darted from the inner corridors to follow her. They passed where a teenage boy sat clutching a skateboard and doubled over in pain. J.S. must have deemed him stable enough to wait, but Earl didn't like the greenish tinge and sheen of sweat that no mask could completely hide. "Do you need to lie down?" he asked, walking over and kneeling at the young man's side.

"I need to vomit, sir."

"Just hang on." He rummaged through the equipment racks behind J.S.'s triage area, dug out a bedpan, and shoved it into the youngster's lap.

The sounds of more ambulances pulling into the unloading area reached his ears.

Busy day to break in a fresh crew, he thought, hurrying inside to marshal his staff for the onslaught. At the door he stopped to double-glove and double-gown, the added body armor required for anyone working ER. He also donned another prerequisite for anyone on the front lines of medicine these days: a cast-iron attitude of que sera sera.

An hour later they'd diuresed a liter of pee from the woman in heart failure, identified a ruptured spleen in the skateboard kid, and resuscitated the case that had so alarmed the ambulance technicians: a diabetic stockbroker in his fifties named Artie Baxter. He'd skipped breakfast after his morning insulin, then collapsed and seized. "I had a great tip before the market opened," he'd explained when a shot of IV glucose woke him up. "So I phoned all my clients instead of eating my usual toast and cheese…"

A few of the nurses scribbled down the company's name and ran for the wall phones.

"Can I see you outside a moment?" Earl said to Susanne Roberts, the head nurse, and led her by her elbow to a quiet spot in the hall.

"What's up?" Her pixie haircut peeking out from under her OR cap made her appear young, and only the lacework of tiny lines that fanned out at the corners of her eyes hinted at her age. She'd been on staff in ER for nearly as many years as he had, but she'd kept her passion for the job long past the point at which most lose it. Like all gifted leaders, she brought out the best in those around her.

"I'm going to try to make the end of the orientation session for the residents," he told her. "But I'm worried about this guy. Keep him on the monitor with the IV running."

"You expecting trouble?"

"His story doesn't add up. A man who's been on the needle for years and he pulls a stunt like that? I think he's not telling us something. And all that stock talk- a little too smooth for my liking. He got a wife?"

"She's on her way in."

"Ask her if he's been as well as he claims."

The speeches were almost over when he let himself in through a side door near the front of the auditorium stage. The audience occupied a steeply raked semicircle of seats, providing a wall of OR green before the speaker at the podium, Dr. Stewart Deloram, St. Paul 's resident genius in critical care. His mop of jet-black hair sprang out from the sides of his headgear like burst springs, flopping about as he animatedly extolled the virtues of a quiet, calm demeanor while dealing with life-and-death situations. "Especially when working on a patient who has suffered cardiac arrest," he emphasized in a grave, sonorous voice.

As the director of the intensive care unit, and one of the hospital's biggest screamers, he ought to know.

The two-thirds of the audience who were familiar with Stewart's antics tittered. Those who weren't dutifully jotted down what he'd said. Yet every single resident who had just laughed would also willingly double their allotted time with him in ICU, so brilliantly did he teach the art of critical care, or "raising the dead," as he called it.

Earl didn't care how loud Stewart got during a resuscitation, so long as he got the job done. The patients sure were in no state to hear him, and besides, other geniuses made noises when they worked. Just listen to undoctored recordings of Glenn Gould. Or to Monica Seles when she served.

Earl spotted the chief of surgery, Sean Carrington, a giant of a man seated in the front row, and slid in beside him. He wielded enormous influence in the hospital and more than once had used it to save Earl's hide politically. But Earl appreciated him most for his zany sense of humor. Sean could cut through the suffocating bureaucracy of academic medicine like a blast of oxygen. And his bushy red eyebrows, highlighted by his mask, whipped up a laugh all by themselves when his jokes failed.