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'There are a couple of things I'd like to consult with you about,' Rick said, 'if I could meet you in the acute care unit before you leave for the day.'

'Sure,' Clay said. 'I can be there in about twenty minutes.'

'I also admitted a patient from Emergency, just about half an hour ago,' Rick said. 'I'd like you to see him as well. He's got epigastric pain, right upper quadrant abdominal pain and slight jaundice. When I examined him I felt a liver mass. He has a bit of a cough, too.'

'What do you think?' Clay asked.

'Well, the first thing that came to mind, of course, was cancer of the head of the pancreas, with secondaries in the liver,' Rick said, 'but it doesn't seem quite right for that...he's not ill enough. With a liver mass like that, he would have lost a lot of weight by now and be pretty unwell. He doesn't think he's lost any weight, and the chief complaint is the pain.'

'Hmm. How old is he? And is he an alcoholic?'

'He's fifty-two and, no, he doesn't drink much,' Rick said. 'I haven't ordered any tests yet. I wanted you to see him first.'

'What's his job?'

'He's an aid worker with an international organization, so he's travelled a lot.'

'Hmm,' Clay said again. 'Find out exactly which countries he's been to, Rick. That could have some significance. Then order a straight chest X-ray and an ultrasound of the liver. Get those done right away, then book a CT scan to be done on an emergency basis.'

'Right. He's on the regular surgical floor right now.'

'I'll be with you shortly,' Clay said.

From a drawer in his desk he took out a folder containing the latest version of his curriculum vitae, which he planned to deliver in person to the administrative assistant who was responsible to the search committee looking for the new chief of surgery. With it, he had a list of ten colleagues who'd agreed to be referees.

As he was about to leave his office, the telephone rang. 'Dr Sotheby here,' he answered.

'Hi, Clay!' It was Dawn. Clay had a momentary sense of surprise at the sound of her voice, a slight feeling of dissonance, as though he were beginning to forget that he and Dawn had an ongoing physical relationship, however sporadic it had become of late.

'Dawn...how are you?' he said, trying not to let her intuit that she was the last person he'd been thinking of. It occurred to him then that if she didn't continue taking the initiative, the affair might just fizzle out from lack of attention on his part. It wasn't that he didn't find her attractive...he did. Her particular brand of voluptuous femininity was always enjoyable, yet that seemed to be largely the limit of the attraction. She would be a great wife for someone, a good hostess, a good organizer—but not for him.

'I'm fine,' she said brightly, 'but missing you. I was hoping you could come over here tonight, to my place, for supper...and perhaps stay.'

'I'm tempted,' he said truthfully, his stomach grumbling from hunger, 'but I've still got things to do here, patients to see, so I'll have to get something to eat here. I'm just leaving the office now.'

'Come after, then,' she said huskily.

Clay hesitated. 'I'll come later,' he agreed, 'but I can't stay the night. I have a feeling I might get called.'

'Sure,' she agreed.

'What we may have here,' Clay said later to Rick, when he'd seen his post-op cases and was looking at the chest X-rays of the newly admitted man with the liver mass, 'is a parasite infection.'

'That's what the radiologist said,' Rick commented, referring to the MD who specialized in radiological diagnoses, 'because these rounded shadows in the lungs look like cysts made by parasites.'

They were in the X-ray department, looking at the newly developed films, while the patient himself, John Tanner, was undergoing an ultrasound examination of the liver. 'So he's worked in South America,' Clay said. 'Chile and Argentina.'

'Yeah,' Rick said. 'I had a quick look in a textbook before you came to confirm what parasites could cause liver masses, and I came up with the parasite that's passed to humans from the faeces of dogs in cattle country. From cattle, to dogs, to humans—that's the cycle for the
Echinococcus
parasite.'

'So the liver mass could be a hydatid cyst, formed by the growing parasites, which can take from five to twenty years to form such a huge mass and cause symptoms,' Clay said.

'Yeah.'

'We'll get the CT scan done this evening. Can you call me at home when it's done? If the diagnosis is confirmed, we should start him on a drug, albendazole, which can kill the parasites, but it takes time,' Clay said. 'The real danger for these patients is that a cyst could rupture and produce anaphylactic shock—all that foreign matter released into the tissues and blood stream.'

'Yeah, that's what I thought,' Rick said.

'So we have to be prepared ahead of time to deal with that. We'll have to alert the medical and nursing staff and have the necessary drugs on hand. If that should happen, I want to be called, of course.'

'Right,' Rick said. 'The last time I saw that, it was in a kid who was allergic to peanuts—he ate a minuscule amount of peanut butter by mistake. Fortunately, he wasn't far from the hospital when it happened, but we nearly lost him. I guess we need to have the cortisone and epinephrine on hand, and the antihistamines, as well as the resuscitation equipment.'

'Yes.'

Anaphylactic shock was a cataclysmic allergic reaction, which could be fatal. There was a certain protocol that had to be followed for that acute medical emergency, so all levels of staff would have to be ready.

'Otherwise, it should be surgically removed?' Rick asked. 'The hydatid cyst?'

'Yes, but again there's the risk of shock when you cut into it—all that foreign matter getting into the bloodstream—so really I would like to have him take the drug for at least a few days first,' Clay said, 'before we operate. If there's a bed, I'd like him transferred to the acute care unit. They have more nurses there, better attuned to a crisis situation. Make sure they know precisely what to do if the thing ruptures.'

'Right,' Rick said. 'I'll get on to that right away.'

Clay felt exhausted by the time he got away from there to go to the cafeteria for a hasty meal. In a way he regretted not taking Dawn up on her offer to give him supper, but his gut feeling had told him not to get any closer to Dawn in a domestic sense than he was already. Somehow she'd insinuated herself into his life...and he acknowledged that he'd taken advantage of her sexual availability.

As he sat at a table and spooned soup into his mouth, instantly feeling more alert, he thought of Sophie's remark about the hospital gossip that he and Dawn would marry if he got the chiefs job. Now where had that idea come from? He felt a reluctance to bring it up with Dawn herself. Maybe it was time for him to pull back from Dawn. Maybe the gossips knew something he didn't. Up to now, he'd felt that she'd been using him as a stud, much more so than the other way around.

*

He let himself into Dawn's apartment, in an exclusive area not far from the hospital, with his own key which she'd given him months before. Soft music and the odour of scented candles greeted him as he entered. The curtains had been drawn and the whole place was in semi-darkness.

'I'm here,' he called out. 'Sorry to be so late. Can't stay long, I'm expecting a call.' He assumed that they would have a drink together, chat a bit, maybe make plans to got to the theatre some time, then he would go.

'I'm in the bedroom,' Dawn called.

Where else? Clay found himself thinking wryly, while calling himself a hypocrite at the same time.

She was reclining in the bed, with only a sheet over her, exposing her bare shoulders and outlining her breasts. 'I thought you'd never come,' she said, holding out her hand to him.

Without going over to her, he began to undress, flinging his clothes on a chair.

'Hurry,' she whispered.

When he was undressed he went into the shower off her bedroom, letting the welcome jets of warm water wash away his fatigue. With Dawn's shampoo he massaged his scalp.

He emerged, still damp, a towel around his waist. Beside the bed he let the towel drop to the floor. Dawn flung back the sheet and held out a hand to him. 'Oh, Clay,' she whispered.

As he eased himself down onto her she put her arms around his neck and hungrily wrapped her thighs around his hips. At that moment he had a fleeting, haunting vision of a woman in a bluey-purple dress running away from him down a garden path, with a flash of auburn hair glinting in the light of a streetlamp.

The next day the diagnosis was confirmed on John Tanner. He definitely had echinococcosis, an infection in humans caused by the larval stage of the parasite
echinococcus granulosus.

'Better that than cancer of the head of the pancreas,' Clay said succinctly to Rick and the surgical intern when they met for a consultation on Mr Tanner in the acute care unit. They looked at the report from the CT scan.

'I've been in touch with the pharmacy to see if they have the albendazole in stock,' Rick said, 'and they have. I told them we're going to need a lot of it.'

'Good,' Clay said. 'We'll start him on that right away, then maybe I'll operate towards the end of next week, depending on his condition. Obviously, the fact that he has jaundice means that there's some obstruction of the bile ducts...we can't leave that too long. On the other hand, I want to give the drug a chance to work. During the operation to remove the mass of cyst, we can kill off the larvae with hypertonic saline—that has its side effects as well, unfortunately.'

'Can I be there, sir, when you do the operation?' the intern asked eagerly. 'This may be my only chance to see a hydatid cyst.'

'Sure,' Clay said. 'Dr Sommers here will keep you informed of progress. Maybe you would like to present this case at the surgical rounds. You could do it in two stages—pre-op and post-op.'

'Yes...yes, I would,' the intern agreed enthusiastically.

The remainder of the day went quickly. Wednesday dawned bright and clear, another operating day.

'Morning, lovely Sophie,' Rick said cheerfully as they all met once again in the scrub room outside room four in the operating suite. Clay felt that he practically lived in that place—he certainly spent long hours there. It was nice, he realized as he tied on the usual face mask, to see Sophie again. His interest quickened as his eyes lighted on her trim figure as she washed her hands for his first case.

'Morning, Dr Sommers.' She smiled. 'Morning, Dr Sotheby.' Her hair was shoved up into one of those unbecoming paper caps, her face obscured by the mask and goggles as usual, yet he sensed a softening in her body language.

'Good morning,' he said. 'I see I've got you for another gut resection.'

'Yes. I've got to the point where I could do it in my sleep, I think,' she said lightly. 'But one mustn't be complacent, I guess.'

Rick went out to have a few words with the patient who was on the operating table, waiting to have the anaesthetic. Seeing him go, Clay wondered whether Rick had an intimation that he, Clay, was becoming more than ordinarily aware of Sophie and was giving him a rare few minutes alone with her. No time like the present, Clay thought.

'I've been wanting to tell you again how much I enjoyed our date,' he said. 'I would have called you, but your number is rather hard to get. The OR staff won't give it out, of course.'

'No—otherwise any Tom, Dick or Harry could get hold of it.' She laughed.

'Do you mind if I have it?' he said baldly, knowing that she had to go in a moment to prepare for his case.

'Well...no, I don't mind,' she said, with no particular inflection in her voice, so that he couldn't tell what she was thinking. 'I'll give it to you later on.'

'Will you come out to dinner with me again some time, Sophie?' he found himself saying, without having planned it. Again he felt a slight sense of dissonance, as though someone else were speaking for him. At that moment, Rick returned hurriedly to begin scrubbing.

'Um...' Sophie looked at Clay. 'Yes, all right,' she said. 'I...guess I'll speak to you later.' With that, she turned off the taps with her elbows and backed through the swing door into the operating room.

If Rick picked up any vibes, he was too tactful to indicate the fact as he busily tore open a packet containing a sterile scrub brush and then let water pour over his hands and arms. 'Any news about the chief's job, sir?' he said. 'I guess the search committee is gearing up to do their thing.'

'They have all the paperwork they need,' Clay said. 'Now it's up to the fates.'

During a coffee-break, after the first case, Sophie handed him a piece of folded paper as they were both about to enter the coffee-room for the short break. 'This is my number,' she said, giving it to him quickly. 'Please, don't let anybody else have it.'

'I won't. May I call you this evening?'

Sophie nodded, then went ahead of him into the coffee-room. Clay saw that her face was slightly flushed.

When they were in the same room these days he felt his eyes straying more and more in her direction, and he chided himself for it. He had a perfectly good relationship with Dawn. He definitely didn't want to get involved with another woman, who would undoubtedly complicate his life, he chastised himself somewhat irritably, at a time when he was preparing more and more to concentrate on his career.

All he really wanted, he told himself as he poured himself coffee, was a good sexual relationship with a mature woman—one who would want the same things that he wanted, who wouldn't demand anything else.

As he drank his coffee, standing up, he saw that one of the other young surgeons was talking to Sophie and that she was laughing. A sudden, irrational stab of jealousy took him by surprise, so that he had to turn away from them. The remark she'd made, that men wanting to make love to her was an occupational hazard, came back to him. For once, he knew that he didn't have a clear field.

Quickly he swallowed the last mouthful of coffee and left the room, dragging his concentration back firmly to his next case on the operating list.