“I’m terribly sorry about Eden. I hope you didn’t feel pressured to come back so soon.”

“I couldn’t stand that empty house any more. Karen’s also gone back.”

Gilda nodded. She turned to the patients in the waiting room.

“Doctor Avery’s had a death in the family.” There was a general murmur of sympathy.

“Is Gordon at the hospital?” he asked Gilda.

“He’ll be back about eleven.”

One by one, the patients repeated their condolences as Alan attended to them. None was more vocal than Ella Williams. “Your daughter! Why, she must have been a mere child!”

“Seventeen.”

Mrs. Williams shook her head. “I lost one of mine age ten. It’s never been the same, even having three more. The one you lose is always your favorite, or gets that way after she dies.”

“She was my only one.” He regretted the words instantly.

“Only one! Oh dear, oh dear. Doctor, isn’t there something I can do? Maybe your wife needs some help around the house. Can I send her a cake? Can I send one of my girls to help cook or something? She shouldn’t be all alone at this time, and having to fend for herself.”

Alan missed the similarity between Ella’s and Esther’s logic ― and Ella’s had nothing to do with Jewish tradition. Reacting to her manner of expression, he smiled to avoid laughing out loud. He knew she meant every word, but such solicitude from a stranger was foreign to his experience. “You’re very kind, Mrs. Williams, but really we’re OK.”

“Well now, you ask your wife. Men don’t always know what women need.”

~~~~~~~~~~

Gordon didn’t get back till almost noon. “I’m sorry, Alan. Do you feel like going to lunch? My first appointment isn’t till two.”

Gordon drove to the FLYNT [Food Like You Never Tasted], a restaurant off the Schuylkill Expressway.

“I never heard of this place,” Alan said. “A name like that should get around.”

“I go here when I don’t want to meet anyone I know. I thought we might want to talk undisturbed. Food tastes the same as anyplace else, never mind the hype.”

“I haven’t had the heart to talk to Rick,” Alan said. “I could go straight to Pathology, but that would seem like bypassing him.”

“Pathology? What’ve they got to do with it?”

“How bad was the valve? Did she have endocarditis? You know, the autopsy. But maybe it’s academic. We know she had rheumatic heart disease, and even if the valve wasn’t infected now it could’ve become infected any time.  Still, it would be reassuring to know it wasn’t.”

Gordon couldn’t figure out what Alan was driving at. The food ― soup in square bowls, sandwiches on octagonal slices of bread ― was served. “See? It is different,” Alan said.

“Only looks that way. Anyway, I can get you the autopsy results if you like.”

“No, that’s OK. I’ll take care of it.”

“Look, Alan,” Gordon said suddenly, “you know it wasn’t any of those things—”

“I don’t know that,” Alan insisted. “She was septic. People die from septic shock.”

Gordon was taken aback by the harshness of Alan’s tone. For some reason, Alan seemed bent on avoiding any reference to the real cause of death.

Alan took a deep breath. “I’m sorry I blew up.”

“No apologies needed. This is all very hard for you.”

“Of course,” Alan said, squirting catsup on one of the isosceles triangles of his sandwich, “the results may not be complete. No sense being impatient. Rick’ll probably call me.”

“Maybe,” Gordon said, emptying his cup.

It was Alan’s turn to be puzzled. “Why shouldn’t he?”

“He may have been instructed not to.”

~~~~~~~~~~

Alan headed for the records room, where several charts of patients he had discharged awaited his review and signature. As he worked he noticed, behind one of the staff desks, a young woman he had never seen before. A few moments later the chief librarian passed him and offered her condolences. “Looks like you’ve got someone new,” he said.

“That’s Adele Bright. Started last week. Want me to introduce you?”

“No, I want to finish these. I’ll introduce myself later.” In good time he walked over to Adele Bright’s desk and deposited a stack of records.

“Thank you,” she said with a smile. “Is there anything else I can get you?”

Alan leafed through his date book. “Do you have Eden Avery ? She was here a week ago.”

Ms. Bright keyed the name into her computer. “Patient of Doctor Harmon?”

“That’s right.”

“I still don’t know half the doctors here,” she said apologetically. “I’m Adele Bright.”

“Nice to meet you.”

She went off and returned empty-handed. “It’s not there. Let me check something.”

Another brief conference with her computer provided the answer. “That chart’s been traveling,” she said admiringly. “It was signed out to the second floor last Tuesday. Next day it went to Pathology. Thursday to the Pediatrics office. Next thing, Administration. As far as I can tell, that’s where it is still. Should I call them?”

“Don’t bother.” He tried to smile condescendingly. “They’ll return it in their good time.”

Gordon was right. No lawsuit had even been threatened, and already the defenses were going up. Alan could hear his name whispered in the medical staff lounge, cafeteria, operating rooms, and God only knew where else. His continued silence would only confirm in the minds of his colleagues and the administration that he was laying plans to sue. Without a thought to the mild deception he had committed, he returned to his office and asked Gilda to call Rick.

His buzzer sounded. “I have Doctor Harmon’s receptionist. She says he’s with a patient.”

“Ask to have him call me as soon as he’s free.”

An hour later Rick had not returned the call. This was unusual. Rick made a point of returning calls promptly or having his receptionist explain the delay.

When he arrived home, Karen was preparing dinner. “We can eat in fifteen minutes,” she said. “If you’re having a drink, I can use one too.”

He made drinks and headed for his study. “I want to make a call before we eat.”

“Hi, Rick, it’s Alan Avery.”

“Oh hi, Alan. How’re you feeling? How’s Karen?”

“We’re back at work. I guess you know that. I tried calling you at the office.”

“Yeah, I’m sorry I didn’t get back to you. It was a hectic day. And we’re about to sit down to dinner. Maybe we can talk later.”

“I just wanted to let you know we’re having a memorial service for Edie a week from Sunday. We thought you might want to come, being her doctor since the day she was born.”

“I’m sorry, I can’t. I’ll be out of town. But my thoughts’ll be with her, and with you.”

That was all. Alan’s hand was trembling. Eden had been a favorite of Rick’s; he had twice seen her at death’s door, had delighted in her resilience, had nurtured her interest in medical matters, been friend to the family. If he was disappointed to miss the last tribute to her life, his words conveyed the bare minimum of that sentiment, his tone none at all. Gordon was right.

The dinner announcement interrupted his thought. “You look preoccupied,” Karen said.

“Edie’s record has been impounded by the hospital administration. Rick didn’t return my call. I caught him at home and told him about the memorial service. He’ll be out of town. He was itching to get off the phone, I could hear it in his voice. You know what that means?”

“Of course.” Her tone was nonchalant. “They’re setting up for a lawsuit. No one gets to touch the chart, and everyone associated with the case has been silenced. Routine procedure.”

“No one’s even talked about a lawsuit.”

“They see it coming. Someone up there’s drawing a nice fat salary doing risk management. To the outside world that’s to minimize risk of harm to patients; inside the office it’s risk of damages from malpractice suits.”

“Well, let them do whatever they want in their damn office. But they have no business souring relationships among the medical staff. I have no intention of suing them.”

“I do.”

Alan laid down his fork.” You what?”

“Listen, Alan,” she said, leaning across the table till her face was a mere foot from his, “you know, I know, and they know that that child of ours was killed by carelessness. We have books in the office. I know they could have treated her without using a penicillin drug. If I’m wrong, better tell me this moment, because that’s the only thing that’s going to stop me—”

“They could have used vancomycin.”

“All right. My God, when I think that of all the penicillin drugs out there, he had to pick one with a name you can’t recognize. I could’ve stopped him. . . . Well, they’re going to pay.”

Alan looked tired.  “What are we going to do with the money? There are no expenses; it’s all punitive. It won’t bring Edie back. Just cause a lot of hard feelings for no good purpose.”

“I can’t believe I’m hearing this,” Karen said, eyes blazing. “Wake up, Alan! Do you realize what’s happened?”

“Yes, I realize.” Alan’s voice was rising. “And I also know we can’t turn time back. I’m not interested in vengeance.”

She drew back, arms folded, and looked at him calmly. “You haven’t lost what I’ve lost.”

Alan felt a chill. “What are you saying? Do you think she was less to me than to you?”

“In a parental sense, I guess not.”

“‘Guess not, guess not.’ What the hell are you driving at?”

“OK, I’m sorry. I didn’t mean to imply that you weren’t a good father.”

“Then would you be so good as to tell me just what you did mean?”

Karen’s calm began to give way to anger. “You gave up nothing to raise her. So you lost your daughter, but your career was doing just fine all the time she was growing up and you’re not about to jeopardize it by rocking the boat, are you?”

He took a deep breath. The silence was palpable. He nodded slowly. “So that’s it.”

“Yes, that’s it!” she shot back. “Do you want to hear it in detail?”

“That’s not necessary. I know it ― right back to the abortion you didn’t have. You have a powerful weapon. With one stroke you can compensate for your career and destroy mine. So you punish McCrae, or Harmon, for allowing Edie to die, and me for insisting she be born.”

“I’m not trying to punish you, just to beat some sensitivity into you for what this has cost me. I have nothing left. Do you understand? Nothing!” He would have liked to comfort her but he felt too stung by her attack to move. How awful, he thought, just when a couple need each other’s support they cut it off by casting blame and cruel accusations.

He got up and carried the dishes to the counter. Then he slowly walked to his study and sat on the sofa. As he tried to figure what was next, she entered softly and sat in the armchair.

“We’re both mourning for our only child,” she said. “It’s not as if one of us was accusing the other of killing her, so why do we have to fight?”

“I was asking myself the same thing. We should be consoling, not accusing each other. So what are we going to do? We seem to be miles apart.”

“I just can’t let it go. As if we hadn’t been hurt enough, we have these despicable tactics by the hospital. Now I know how it feels to be stonewalled. And Rick, that hypocrite!”

“I don’t think a lawsuit should be started because of the anger of the moment, no matter how justified it is,” Alan said. “We do have to think of the consequences. If we go through with it, win or lose, I’m finished at Cresheim Valley and in the medical community.”

“Then, why can’t we move elsewhere? What’s to keep us here?”

“Now we’re in the realm of fantasy. Our home is here, our friends, and ― I say this deliberately ― both our careers. Can’t we think about this awhile? Don’t we have two years?”

“Time might dissipate my anger at Rick, who’s undoubtedly following orders. But the rest is unchanging. If you want to wait, OK, but I’m not changing my mind. Before that statute of limitations runs out, I’m going to claim my day in court.”

Later, as she lay sleepless in bed, she conceded that whatever chance she had for professional achievement lay with F & D. Nowhere else would she be assured of the support and goodwill she enjoyed there. Maybe moving elsewhere wasn’t such a good idea. She’d give herself more time ― but only to find a way to neutralize Alan’s fears.

Alan, meanwhile, was having second thoughts of his own. Maybe moving wasn’t such a bad idea. Internists were in demand everywhere.  Classified ads in the medical journals were full of enticing offers. Come to think of it, starting over might be easier for him than for Karen. Buoyed by the feasibility of that option, he was about to fall asleep when another idea jolted him awake so hard he was afraid Karen might notice. His imagination placed him in the courtroom where the case of Avery  v. Cresheim Valley Hospital was being tried. He had been called to the witness stand by Bobbie Buehl, who wanted to impress the jury with the plight of a father bereft of his only child. The cross-examination was in progress.

DEFENSE COUNSEL: Doctor Avery , did your daughter have an underlying condition before the knee became infected?

ALAN: Yes.

COUNSEL: What was that condition?

ALAN: Rheumatic heart disease with aortic valve insufficiency.

COUNSEL: Is that condition serious?

ALAN: Yes.

COUNSEL: Please explain in what way it is serious.

ALAN: In a number of ways. Insufficiency of the aortic valve can lead to heart failure or even sudden death. To prevent that, it may be necessary to replace the valve, and that is major surgery which can also kill her. Then, a damaged valve is susceptible to bacterial infection, called bacterial endocarditis. That can kill her directly, or it can further damage the valve.

COUNSEL (shaking his head sorrowfully): That sounds like an awful burden for a young girl to live with. Explain to us if you will, doctor, how one gets rheumatic heart disease.

FRANK FRAZIER: Your Honor, I object to this line of questioning. He’s treating the patient’s father like an expert witness.

DEFENSE COUNSEL: Your Honor, this witness is a physician. I’m only trying to establish that he has been familiar throughout with his daughter’s condition.

JUDGE: I’ll permit the questions on that basis. Objection overruled. Proceed.

COUNSEL: Doctor, you were about to explain how one gets rheumatic heart disease.

ALAN: It’s a long-term complication of rheumatic fever.

COUNSEL: And how does one get rheumatic fever?

ALAN: Following a strep throat.

COUNSEL: Does that mean that I can get rheumatic fever, and then rheumatic heart disease, and endocarditis, open-heart surgery, and all that, any time I get a strep throat? And how about my eight-year-old son, and my five-year-old daughter?

ALAN: Yes, you can, and they can. If the strep throat isn’t treated in time.

COUNSEL (suddenly stopping in his tracks on the way to his table and turning to Alan): You say “treated in time.”  Does that mean, treatment in time can prevent rheumatic fever?

ALAN: Yes.

COUNSEL (frowning, hands clasped behind his back): Did your daughter have a strep throat before she got rheumatic fever?

ALAN: Yes.

COUNSEL: Was she treated in time to prevent rheumatic fever?

ALAN: No.

COUNSEL (pacing back and forth): Who was her doctor when she had her strep throat?

ALAN: Doctor Richard Harmon. (Murmurs from spectators.)

JUDGE (gaveling): Order, please.

COUNSEL: Who took your daughter to see Doctor Harmon, you or your wife?

ALAN: Neither of us. It didn’t seem that serious. (Karen, who was sitting with the spectators, looked at him expressionless.)

COUNSEL (stopping his pacing again): Not serious! Wasn’t her throat sore?

ALAN: Yes, but so is a viral sore throat.

COUNSEL: Well, if you didn’t take her to Doctor Harmon, who decided what treatment if any to give your daughter?

ALAN: I did.

COUNSEL (feet apart, facing Alan squarely): You’re a practicing physician, aren’t you, Doctor Avery ? (Subtle emphasis on the “doctor.”)

ALAN: Yes, I am.

COUNSEL: Do you practice a specialty?

ALAN: Yes.

COUNSEL: What is that specialty?

ALAN: Internal medicine.

COUNSEL: Are you board certified in internal medicine?

ALAN: Yes.

COUNSEL: Does treatment of strep throat come under the specialty of internal medicine?

ALAN: Yes.

COUNSEL (walking to the jury box and from there, feet again apart, addressing Alan): So you, doctor, a board-certified internist, did not take your daughter’s strep throat seriously. As a result of your not taking your daughter’s strep throat seriously, you did not give her penicillin; you did not take her to see Doctor Harmon, who might have given her penicillin; she developed rheumatic fever; and she ended up (voice rising continuously) with a damaged valve, possibly facing heart failure, open heart surgery, bacterial endocarditis, sudden death—

FRANK FRAZIER (on his feet): Ob-jection! Counsel is haranguing the witness.

JUDGE: Sustained. Counsel, please refrain from sermons. Question the witness.

COUNSEL: All right, I withdraw the question. (Sits down at table shuffling papers. Addresses judge: “If Your Honor pleases, one moment to find what I’m looking for. Ah, here we are.” Rises to address Alan.) Doctor Avery , when a damaged valve becomes infected, where do the bacteria come from?

ALAN: Through the blood stream.

COUNSEL: How do they get into the blood stream?

ALAN: Usually from the mouth. That’s why patients with damaged valves get antibiotics prophylactically when they have dental procedures.

COUNSEL: Did your daughter have a dental procedure recently?

ALAN: No.

COUNSEL: Are there other places that the bacteria can come from?

ALAN: The urinary tract is next most common.

COUNSEL: Did your daughter have a urinary tract procedure recently?

ALAN: No.

COUNSEL: Is it possible for the bacteria to come from a skin infection?

ALAN: Yes.

COUNSEL: Like an infected knee, for example?

ALAN: That’s possible.

COUNSEL: Did your daughter recently have an infection on her knee?

ALAN: Yes.

COUNSEL: Who took her to see Doctor Harmon, you or your wife?

FRANK FRAZIER: Objection, Your Honor. No foundation.

COUNSEL: Let me rephrase. Did your daughter visit Doctor Harmon for an examination of the knee, with or without one of her parents?

ALAN: No.

COUNSEL: Who treated her?

ALAN: My wife and I.

COUNSEL: Who called the shots as to the type of treatment?

ALAN: I did.

COUNSEL: Was her knee getting better on the day she was taken to the hospital?

ALAN: No, not yet.

COUNSEL: So your daughter had a knee infection, from which bacteria can get into the blood and infect her damaged heart valve; you did not take her to her doctor; (voice rising continuously) you yourself called the shots; her knee did not improve; and she ended up as an emergency in the hospital and died. Is that right?

FRANK FRAZIER (knocking his chair over backwards): Objection, Your Honor! Counsel is haranguing the witness again. He is clearly flouting your orders, Your Honor. I ask that the jury be instructed to disregard these uncalled-for remarks.

JUDGE: Sustained. The jury will disregard defense counsel’s last remarks, and I must caution you, counsel, against any further outbursts like that.

COUNSEL: Your Honor, I withdraw the remarks.

Alan eased himself out of bed, thankful that Karen was now asleep. “Bastard!” he mumbled, forgetting that the entire scene had been a construct of his imagination. But that, he reflected, is what twenty years of marriage to a lawyer does to you: You become an expert on courtroom shenanigans ― including the calculated inappropriate statements that the jurors are told to pretend they never heard. Well, thanks to Sara Walsh, his therapist, his mind no longer resorted to obscure dreams to reveal his inner fears; now he could suffer in full consciousness.

He heated a cup of stale coffee. All right, the details of the cross-examination were invented. But the facts on which it was based were not. He was not prepared to expose himself even to the defendant doctors, who knew Eden’s history.  As for their attorneys, they would tear him to shreds in their own way. No, he was in no position to cast the first stone.

He would keep putting Karen off, hoping that her lust for revenge would dissipate.