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It was a little after four in the afternoon when David Rosenkrantz turned his car into the parking lot of the small commercial building where Robert Hawthorne had his office. In its previous life, the building had been a warehouse, but like much of the renovation in downtown St. Louis, it had been recycled. It now had an upscale restaurant on the first floor and boutique offices on the second. When Robert Hawthorne—or Mr. Bob, as he was known to his operatives—came to town, first to found a company called Adverse Outcomes and subsequently to set up Operation Winnow, he had found the space and thought it convenient, since it was close to the law offices of Davidson and Faber. David didn't know what the relationship was with the law firm, and he knew he wasn't supposed to ask. What he did know was that Robert was called over there on a fairly regular basis.

It wasn't often that David was in town, since it was his job to travel around to the various cities and check in on the field operatives and deal with them as necessary. This was not an easy job, considering the oddball characters they had functioning as independent contractors. At first David just put out fires, but now that he'd worked for Robert for more than five years, he'd been entrusted with recruitment as well. The recruitment was more fun and challenging. Robert would come up with the names from an old Army buddy who still worked in the Pentagon. They were mostly people who had worked in some sort of medical capacity in the military and who had been discharged less than honorably. David hadn't been in the military himself but could appreciate how the experience could affect people who were trying to return to civilian life, especially those who had seen any sort of combat. With Iraq grinding on, they had plenty of potential recruits. Of course, they also looked for people fired from civilian hospitals. Most of those tips came from people who were already embedded.

The door to the office was unmarked. David rapped on it with his knuckle in case Yvonne, the secretary, who was also Robert's live-in girlfriend, was in the back office. It wasn't a big operation. Robert, Yvonne, and David were the only employees, and for quite a few years, it had been just Robert and Yvonne.

There was a loud click of the locking mechanism as big-busted Yvonne opened the door. With her syrupy, southern-accented voice, she coquettishly invited David to step inside. Her syntax was interspersed with a lot of "honeys" and "dears," but David wasn't fooled. Despite the bleach-blond hair and the floozy affectations like spike heels and a short skirt, he knew that she worked out regularly with Robert and was proficient in tae kwon do. David felt sorry for anyone who might mistakenly decide after a few drinks to take advantage of her flirtatious behavior.

The office was simple. There were two desks, one in the front room and one in Robert's inner office, two computers, a couple of small tables, a few chairs, a file cabinet, and two couches. It was all rented.

"The ugly old boss is in the back room, honey," Yvonne whispered. "Now don't you go off and upset him, you hear?"

David had no intention of upsetting Robert. He knew something was up when Robert called him in. David had arrived back in town the night before, after a number of days on the West Coast, and was supposed to be enjoying some downtime.

"Sit down!" Robert said when David entered. Robert was at his desk with his legs crossed and his feet perched on the corner, hands behind his head. His Brioni jacket was tossed over the arm of the couch.

"You want any coffee, dear?" Yvonne questioned. There was an Italian espresso machine on the table in the front room.

David smiled and thanked Yvonne but declined. He looked at Robert, who had his lips pressed together in an expression of frustration. "I got some bad news a little while ago," Robert said. "It seems that our little Hungarian number in the Big Apple just can't control herself."

"Another shooting?" David asked.

"I'm afraid so," Robert said. "This time, it was one of the doctor administrators. The woman is a menace. She's good, but she's jeopardizing the whole operation."

"Are you sure she did it?"

"A hundred percent sure? No! Ninety-nine percent sure? Absolutely. Shootings follow her around like flies on a hunk of smelly cheese. Obviously, this kind of thing can't go on, so I'm afraid your little vacation has to be put on hold. Yvonne got you a reservation on a flight that gets in around ten-thirty."

"It's short notice. What about a gun?"

"Yvonne's taken care of that as well. You'll just have to make a detour on your way into the city."

"I don't remember her address."

"Yvonne's got that, too. Don't worry, we've thought of everything."

David got to his feet.

"You don't mind, do you?" Robert asked.

"No, I don't mind. I knew it was going to happen sooner or later."

"Yeah, I guess I did, too."

Outside of Laurie's rather dirty office window the gray day had faded into night as she'd pored over the charts yet another time, hoping to find some hidden piece of critical information. As had been the case on her previous readings, nothing jumped out at her.

She had her Post-it notes to show the short strip of EKG to a cardiologist and to get the forensic investigators to clarify the nature of the MASNP test. Other than that, she didn't know what else to do.

She'd also carefully reviewed all of Roger's suspect lists, ranking them in order of their potential relevance. She still thought Najah was the most intriguing and most likely suspect, but the other seven individuals from various hospital departments who worked the night shift and who had transferred from St. Francis to the General around the critical time were almost equally interesting, especially since the entire group had easy access to the patient floors. The next list featured eight physicians whose hospital privileges had been canceled during the immediately preceding six-month period. She'd like to find out if possible what each one had done to warrant the disciplinary action.

Between studying Roger's lists and going over the charts for the final time, Laurie had thought about calling Jack. Although she felt her reaction to him earlier was understandable under the circumstances, she regretted it. She'd been far too precipitous and bitter, and she should have at least given him a chance to speak his mind, even if she suspected he was not going to say what she wanted to hear. At the same time, what she had said to him was unfortunately all too true. She was tired of his indecisiveness, which was the reason she'd moved out of his apartment when she had. Ultimately, Laurie decided not to call. It would have been like throwing salt on a wound. Instead, she decided to wait until morning, and if he hadn't called by then, she would call him.

Laurie stacked the hospital charts into two neat piles. Next to them, she put the notepad with her own list of how all the cases resembled one another. She put the CD

with the digital records on top of the pad. She looked at her watch. It was quarter to seven, which she thought would be a good time to head back to her apartment. She would make herself a light supper before bed. Whether she would be able to sleep was another issue entirely. She hadn't wanted to go home earlier, for fear of becoming depressed. It had been better to stay busy all afternoon to keep from thinking about Roger's death, Jack's aggravating behavior, and her own looming problems.

Pushing back from the desk, Laurie was about to get up when she looked back at the CD. Suddenly, the idea occurred to her to look and see if there was a difference between the digital record and the hard-copy hospital chart—specifically, in respect to the unknown blood test. Maybe she could find a result, and if so, maybe she could figure out what the test was.

Pulling herself back to the desk, Laurie booted up her computer and inserted the CD, scrolling through the pages until she arbitrarily found herself at Stephen Lewis's laboratory values. The print was very small, and Laurie used her finger to run down the column on the left side of the page. Near the bottom, she found MASNP. Running her finger horizontally, she saw the result. It was "positive MEF2A."

Laurie absentmindedly scratched her scalp as she stared at the recorded result. There was no explanation. MEF2A didn't make any more sense to her than MASNP. It was like looking up the definition of an unknown word and finding an unknown synonym.

Laurie took another Post-it from the dispenser and wrote down the result, followed by a question mark. In order to put the new Post-it with the others, which she had stuck to the wall behind her desk, she scooted her chair back and half stood, leaning forward with her hand outstretched.

A muffled cry of pain escaped from Laurie's lips. Instead of pasting the Post-it to the wall, both her hands went down on the surface of her desk to support her weight. She'd gotten a sudden, strong cramp in her lower abdomen, and for a few seconds, she held her position as well as her breath. Thankfully, the pain began to lessen, and Laurie slowly let herself sink back into her chair. She held herself stiffly, lest she aggravate whatever was going on inside her body.

A continuous low-grade discomfort had persisted in Laurie's abdomen following the autopsy on the police custody case. It had waxed and waned to a degree, but it had never entirely gone away. She had characterized it more as pressure than pain until she'd tried to place the new Post-it with the others.

Once the pain had lessened to the point that Laurie could breathe normally, she allowed herself to adjust her weight in her chair by sitting up straighten Thankfully, what had now become an ache stayed at the same tolerable level. Perspiration had appeared on her forehead, and she wiped it off with the back of her hand. She knew she was anxious, but she was surprised that she was anxious enough to perspire so freely.

She wondered if she could have a fever, but didn't think so. Gingerly, she palpated her abdomen with a single finger. In contrast to previous occasions, there was now an area of definite tenderness, which seemed ominous to her. As she had noted earlier, it was exactly the location where the pain of appendicitis occurred.

With hesitation, Laurie slowly got to her feet. It had been the sudden motion of half standing a few minutes earlier that had brought on the current episode, and she was eager to avoid a repeat. Luckily, there was no reoccurrence. Her perspiration was another matter. That had actually gotten worse.

Cautiously, Laurie took a few steps out of her office and into the hallway while continuing to support herself with her hand against the wall. The pain remained bearable. With gathering confidence, she walked slowly down the length of the corridor to the ladies' room. Inside, she got some toilet tissue and wiped herself. The spotting had reappeared, and there was more blood than there had been earlier. She knew she didn't have appendicitis.

With gathering anxiety, Laurie retraced her steps back to her office and returned to her chair. She eyed the phone. She was still hesitant to call Dr. Riley, though now she felt she had little choice. The spotting ruled out appendicitis, and along with the location of the pain, suggested a possible ectopic pregnancy, which was far more serious than a mere threatened miscarriage. Finally, she reluctantly picked up the phone and called Laura Riley's office number. When the operator answered, Laurie gave her name and direct-dial number. Thinking it might expedite the callback, she included her M.D. title and said she needed to talk with the doctor. She said it was an emergency.

As Laurie put the receiver back down, she noticed a new sensation: vague shoulder discomfort. It was so mild that she wondered if she was imagining it, yet it added to her already considerable anxiety. If it was real, it suggested the ominous development of peritoneal irritation. To test the possibility, Laurie carefully pushed in on her abdomen with her index finger, then suddenly took her hand away. She grimaced with a fleeting stab of pain. What she had felt was called "rebound tenderness," and it also suggested peritoneal irritation, which now made her worry that not only might she have an ectopic pregnancy, but that it might have already ruptured. If so, it was a true medical emergency for which time could be a critical factor. She could be hemorrhaging internally.

The phone's harsh ring interrupted her obsessing, and she snapped the receiver up to her ear. She was relieved when Dr. Riley identified herself. Laurie could tell she was on a cell phone and in a public place. Loud conversation could be heard in the background.

Laurie began by apologizing for calling on a Saturday night and said that she had resisted because she worried it was a bad way to start out a professional relationship, but she believed she truly had no choice. Laurie went on to describe her symptoms in detail, including the rebound tenderness. She admitted she'd had discomfort prior to speaking with her on the phone the previous day, but had forgotten to mention it and had thought it could wait until her scheduled visit the following Friday.

"First of all," Laura said when Laurie had finished, "there's no need to apologize. In fact, I would have preferred you call sooner. I don't want to alarm you, but it we should consider an ectopic pregnancy until we can rule it out. You might be bleeding internally."

"I thought as much," Laurie admitted.

"Are you still diaphoretic?"

Laurie felt her brow. It was damp with perspiration. "I'm afraid so."

"What's your pulse, approximately? Is it fast or normal?"

Using her shoulder to hold the phone, Laurie felt her pulse at her wrist. She knew it had been fast earlier, and she wanted to be certain it had remained so. "It's definitely on the fast side," she admitted. She had hoped the sweating and the rapid heartbeat had been due to her anxiety, but Laura's questions had made her acknowledge that there could be another explanation: She could be going into shock.

"Okay," Laura said in a controlled, businesslike voice. "I want to see you in the emergency room at the Manhattan General Hospital."

Laurie felt a shiver descend her spine at the thought of being a patient at the General.

"Could we pick another hospital?" she questioned.