Chapter 2

The rain slapped sheets across the windshield, blurring the yellow glow of the streetlights. Mike heard the clang of a St. Charles streetcar on the median less than a hundred feet from the street, but could not see it in the night darkness.

This was upscale New Orleans, where blocks of multimillion-dollar houses – most unfriendly and pretentious – hunkered among surrounding sections of third-world-style poverty shacks teeming with angry, sick people. He’d long ago started to refuse the stand-up parties – those that involved leaning on hundred-thousand-dollar grand pianos while Mozart or Chopin was expertly, if not loudly, rendered. These were archaic, lifeless caves, excessive living space with echoes. Hell yes, he was jealous, too. The owners had generations of family wealth that he had never had. And they shunned him socially for his lack of aristocratic heritage. He couldn’t help being born poor. It would make more sense, and irritate him less, if these aristocrats turned him away because his breath reeked. Well, maybe their self-perceived splendor was what money did to the soul. He never believed he’d wanted that. Of course it was a rationalization. He’d never had the opportunity to give it a try. He was Cajun, brought up by his mother, worked his way through school next to the privileged, so he was never accepted as one of them. And he believed at times that it was his hard work to grow and thrive in spite of his background that had made him the best surgeon in the state, chief of surgery at the third largest hospital in the country. He’d done it, goddamn it, without the contacts of the upper echelons of New Orleans society. Except, of course, for Clayton. His teacher, his mentor. Clayton guided his promotions and appointments. Professionally, not socially. In the world of surgery. He owed Clayton a lot – at the least, sympathy and guidance that might save Clayton’s career.

He pulled into the drive of Clayton’s turn-of-the-twentieth-century stone house. It had been more than a year since he’d been here. There were sixteen surgeons on service, and, except for department and university functions, Mike never socialized with his colleagues unless absolutely necessary, even after he was appointed chief four years ago.

A lightning flash illuminated the huge live oak in the front yard as he pulled his car under a small portico at the rear of the house to avoid the roof runoff. In the rain-slashed glare of a single spotlight, the wind whipped the banana leaves at the edge of the house. Clayton would probably be in the modern add-on solarium at the rear. The floodlight over the back door was dark, and Mike felt for the bell button and rang.

Catherine, Clayton’s wife, answered. He peered into her wary eyes. He wondered how much she knew. She was two or three years younger than Mike, and more than twenty-five years younger than Clayton. Mike could not imagine Clayton discussing the details of his daily work with her. And to him she’d been pleasant, but distant, always aloof, giving a sense of perpetual subconscious eagerness to be elsewhere. Mike had seen her a few times in the last couple of years, just to say hello in a grocery store, or on the street when she was with Clayton during Mardi Gras or the Jazz Festival.

“Clayton in?” he asked. She stood back and he entered.

She wore a gray workout suit with white side-stripes. Her black hair was in a ponytail, and in the weak ambient light that filtered in from the dining room her face was unusually pale; she wore no makeup. He had always found her attractive, and even in workout clothes she had an elegance he admired.

“Why are you out in this?” she asked without greeting.

“It’s about work.”

“That’s what it’s always about.” She looked away. “He’s in the solarium.”

She didn’t move as he walked from the kitchen through the old portion of the house – the foyer, the dining room with seating for twelve, a hall – all restored and filled with museum-quality, antique Louisiana and European furniture – and then he stepped down through the double doors of the two-story solarium, a lush jungle of hanging and potted plants, vines, trees, and blooms. Clayton’s bottomless-well family money had allowed Catherine – obviously an exceptional horticulturist – to create a showcase of beautiful specimens. She was the pride of her garden group, Mike was sure.

In the solarium, Clayton sat on a sofa with his feet up on an ottoman. He had on a fluffy cotton robe with only his undershorts below, but still wore his white shirt and rep tie from the day. He gathered the front of his robe together.


“Yes, sir,” Mike said. He regretted the “sir” under the circumstances. It was habit. He couldn’t shake the tradition of respect for the guys above you who had decades of experience, although technically, as chief of service, he was now Clayton’s boss.

Clayton picked up a remote and fumbled for the button to cut off the giant-screen TV. He paused. The fourth hurricane of the year was in the Gulf. Red circles next to dotted and solid lines covered the full-screen map. A commercial came on. Clayton clicked and the picture faded.

“You’re looking bushed, Mike. You’re working too hard.” He waved a hand. “Sit down.”

Mike moved past Clayton, who studied a hanging spider plant dangling on a long chain from a ceiling hook thirty feet above, and sat on the edge of a white wicker sofa.

“It’s about today,” Mike said. “Paul’s filed an incident report.”

“Bury it, Mike.”

Catherine came in with a coffeepot and slices of lemon pound cake on a silver serving tray. Her hair was down and brushed now, shining with highlights. Her lips glinted with fresh lipstick.

“Leave us for a few minutes, baby,” Clayton said.

Catherine poured coffee for each of them and left, her silent steps almost ghostly in the damp shadows of the plants. She didn’t react to her dismissal. Being excluded didn’t seem to bother her.

Clayton leaned forward and sipped from a cup.

“I’ve been around for a long time, Mike. I don’t deserve this shit. Make that report disappear.”

Mike shook his head. “It’s not internal, Clayton. It’s gone up the ladder. I can’t stop it.”

“If it goes to the OR committee, we’ll be out of control,” Clayton said.

“It’s out of my control now. It comes from anesthesia.”

“Jesus, man. I know Paul likes you. Talk to him. Make him see the light.”

“He’s concerned, Clayton.” Mostly for the patients. But he also didn’t like the way Clayton’s practice had shifted to the obese. Paul felt the surgery had high risks and questionable benefits.

“He’s not a surgeon, Mike. He shouldn’t be making judgments on us.”

“He’s a damned good anesthesiologist. And he cares for you. Honestly, he thinks as I do. If you step down, this would never get to the OR committee for action.”

“Why would I step down?”

“Cut back, then.”

“The bypass stuff is growing, Mike. Obesity is pandemic. It’s no time to cut back.”

“Do the obese surgery without laparoscopy. It’s the laps that are getting you in trouble.”

Clayton leaned back in his chair and closed his eyes. Mike waited.

“I’m not wrong here,” Clayton said. “I’m the best. One little mistake doesn’t change that.”

“No one’s better than you. But you’ve got to catch up on the new techniques.”

“Is that as friend or chief of service?”


“I’ve done a lot for this department.”

“And for surgery worldwide,” Mike added.

“I don’t deserve this shit.”

“Paul tells me you’ve had other problems.”

Clayton thought for a moment. “For Christ’s sake. It’s temporary. Every surgeon has ups and downs. You know that,” he said.

“It won’t fly.”

“I can’t cancel cases, Mike. I’m booked for months. I might lose my block time if I take time off.”

Mike stared at his untouched coffee. “Telling the committee won’t be enough. They’ll be under a strong moral imperative when it comes to patient safety.”

“I bring in a lot of cases, Mike. I damn near support this department.”

“It’s got nothing to do with how many cases you have,” he said. “You made a mistake, Clayton.”

“I’m telling you. It could happen to anyone.”

“No, Clayton. It did not happen to anyone. Face facts. It would not happen to very many. And it should never happen here again.”

Clayton made a wet hiss with his mouth. “I didn’t need you today!” he said.

“She could have died!”

“You overreacted. You like the glory.”

Mike stood in anger.

Clayton called over his shoulder toward the kitchen. “Honey. Bring Mike a drink. He’s upset.” Then he looked at Mike. “Sit down.”

Mike lowered himself back into the chair.

“Listen up. I’m not stepping down,” Clayton said. “I’ll do the training stuff, but I’m not stepping down.”

Clayton turned on the TV with the remote. Mike shrugged. “I think that’s a mistake.”

“Make it right, then. Bury that report. You owe me,” Clayton said. “You want your drink?”

“Nothing for me.”

Mike knew Catherine was close by, and that she had listened to every word. But she stayed hidden. He let himself out.

Catherine had listened to every word from the dining room. She slipped into the hall when Mike left. She walked back into the kitchen after the door closed and leaned forward with her hands on the counter, her head down.

“Catherine!” Clayton called.

Clayton was becoming impossible. Irritated, unreasonable. He had paranoid fears about the world coming after him and seemed close to striking out against anyone or anything that was close by, especially her and his friends who cared. And now this. A failure that would only make him worse.

“I’m going out,” she said.


“To talk to Mike.”

“It’s nothing to do with you. Keep out of it, Catherine.”

“I’ll be back in a few minutes,” she said.

In his car, with the key in the ignition, Mike paused, resting his forehead on the steering wheel. He had failed. How could he have done it better? Catherine knocked on the window.

“Let me in. I’m wet.”

He hesitated, a sense of dread seizing him. Then he undid the locks.

Catherine climbed in and closed the door. She crossed her arms, her hands gripping her shoulders. She was shivering. She was silent for more than a moment.

“You heard?” he asked.

“Of course I heard, Michael. I was in the kitchen fixing drinks.”

He stared ahead. “It’s serious. He’s got to realize it’s serious. They’re labeling him impaired.”

“It’s you.”

“Not me, Catherine.”

“You took over his case.”

“The anesthesiologist thought she was going to die on the table. She was right.”

“You’ll destroy him. You, especially. He’s loved you like a son, Michael. From the day you came on service.”

The words hurt him. “I failed to convince him to do what’s best for him. That’s what I had to do. But I’ve let him down.”

“You’re the chief of service. He believes you’re the one who will take away his privileges.”

“Never. If it comes to that, it will be the OR committee.”

“You’re the chair of that committee.”

“Without the power to make them go against what they will believe is wrong. He is wrong. And they’ll all believe it.”

“What’s wrong?”

“To let him keep operating when he’s dangerous.”

She turned her head to look at him for the first time. “How can you say that?”

“He’s doing a lot of bariatric surgery and he’s using the laparoscope, Catherine. He has not trained and he’s not adapted well.”

“Help him.”

“I don’t do much of the obese stuff.”

“Help him learn laparoscopy.”

“I can’t get him to agree. He won’t listen to me.”

She looked away and sighed. “He’s so arrogant sometimes.”

“It’s pride, Catherine. Much of the time it’s well-deserved pride.”

“Well, don’t let him fail. He deserves that from you after all these years.”

He shook his head. “You can encourage him to step down. Just for a few weeks. Call it a vacation. Go on a retreat or something.”

“He never listens to me, Michael. I’m a wife, not a colleague. And I haven’t been confident enough around him to be blunt. For years.”

“If he won’t step down, I promise, we’ll watch him carefully. All the staff. We all want to get him through this.”

“And the incident report?”

“There’s nothing I can do. It’s gone too far.”

She opened the door and turned as she got out as if she were going to say something. But she shut the door, and he watched her walk slowly in the rain to the house, her movements tentative, as if she dreaded entering again.


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